A woman in her 30s, 4 months post-op rhinoplasty. This patient had an overly rotated tip, a foreshortened nose, and a bulbous tip. Nasal tip de-rotation using extended spreader grafts was performed to lengthen the appearance of her overall nose and nasal tip refinement was performed. The overall goal is a conservative change of her nose to result in a natural appearance of the nose which fits her face.