A woman in her 40s, who had a previous rhinoplasty which left her with severe nostril asymmetry, alar retraction, an over-projecting elongated nasal tip, drooping tip, and inability to breathe through her nose. She is now four months post-op from revision rhinoplasty with correction of nasal tip asymmetry, placement of alar contour grafts to correct alar retraction, tip elevation, nasal tip deprojection to shorten the overall length of her nose, and placement of a columellar strut graft and spreader grafts using MTF cartilage to add tip support, tip refinement, and improve her breathing.