This is a 42-year-old lady who has a history of significant trauma to her nose. She had repair of facial fractures and multiple reconstructive procedures in the past. She was unhappy with her flat nasal tip, which she felt was sagging. She also had a septal deviation and nasal airway obstruction. She underwent secondary rhinoplasty, using cartilage and bone grafts from her ribs to open her airway and improve the appearance of her nose. She had an excellent postoperative result.