This is a 51 year old woman who had breathing issues and cosmetic concerns about her nose. She had undergone several nose surgeries after injuring her nose in a diving accident. Over the course of her surgeries her breathing had become worse and she suffered from extensive cosmetic deformity of the nose. She underwent a tertiary (revision) rhinoplasty through an open approach. This included a dorsal “bow” graft, alar rim grafts, and tip and dorsal refinement. She did very well after surgery with minimal bruising. At 6 weeks after surgery, she is already very happy with the results. Her breathing is much better and the shape of her nose has been restored to her pre-accident appearance.