This is a 24 year old man with complaints of difficulty breathing through his nose. On exam he demonstrated mid-face under development with a dramatic lack of projection to his nose, a flattened and wide dorsum, and a poorly defined and over rotated nasal tip. He underwent an open rhinoplasty with the placement of rib grafts to provide support and projection to his nose, and nasal tip suture modification combined with grafting to support better define his tip. Post-operatively, he had only minimal bruising and
swelling. At nearly a year after surgery, his breathing has substantially improved and he is very happy the new contour of his nose.