A woman in her early 40’s who was troubled by a bulbous tip and a minor hump. She felt she had “a bulb on the end” of her nose. She also had some internal nasal valve collapse, the type that is improved with “Breath rite” strips. She is shown before and again, 2 years after an open rhinoplasty combined with spreader graft placement to correct the valve collapse. She is thrilled with the improved shape of her nose, and is able to breath more easily as well.An open rhinoplasty was performed through an incision across her columnella.