This 56-year-old Asian woman had a prior rhinoplasty performed elsewhere with a silicone implant and had 2 subsequent revisions. This was her fourth revision rhinoplasty showing a contracted nasal tip, asymmetry, and a tip to bridge ratio that did not look natural. She also had collapsing nasal walls during inspiration. She underwent removal of her prior implant, lateral turn-in flaps, lateral alar wall graft support, caudal septal extension graft to derotate and project her nasal tip, nasal sill reduction, a diced rib graft to rebuild the dorsum of her nose. She is shown before and 3 months after her surgery. She should continue to look better over time.