This 40-year-old woman is shown before and 16 months after a revision rhinoplasty. She was unhappy with the appearance of her nasal tip and she could not breathe from the left side of her nose. During the procedure a left spreader graft was placed so that now she can breathe well. She also had her previous nasal tip graft removed that was causing the distortion and asymmetry to her nasal tip. Her columella that was buckled was straightened. However, she does have a small residual deviation of the nasal tip that was not entirely corrected. She also had dice cartilage wrapped with mastoid fascia and placed onto the over-resected middle nasal vault. She also had her nasal bones realigned and straightened.