A woman in her 40s, two months post-op complex revision rhinoplasty. This patient had seven previous rhinoplasties prior to this which unfortunately resulted in numerous complications including soft tissue tip necrosis, full thickness columellar necrosis with an almost completely absent columella, tip asymmetry, a drooping tip, a dorsal hump, total septal perforation and absence, and inability to breath through her nose. Prior to revision surgery with me, I counseled her extensively that we would not able to completely correct all of these deforminties but rather we would seek improvement and we may require multiple staged surgeries to accomplish all of our goals. She underwent revision rhinoplasty with total columellar reconstruction with MTF cartilage, tip onlay with auricular fascia to address her previous tip necrosis, spreader grafts to straighten her nose and improve breathing, dorsal hump reduction, tip elevation, alar contour grafts, and columellar strut graft for tip support. The overall goal is an improvement in her appearance and breathing.