This lady had originally been unhappy with her nose from an early age due to it being excessively long and thin. She came to see me 13 years later and after having undergone 3 attempts to improve her nose. Her nose was deviated, irregular over the bridge, had an inverted ‘V’ deformity and a poorly-defined, shrunken tip.

At operation note deviation of septum and tip (yellow line), scarred fragmented tip (blue line), collapsed external nasal valve (red line). Cartilage was harvested from the right ear and previous grafts recycled. The nasal bridge was smoothed, nasal bones re-aligned, septum repositioned and secured with spreader grafts, the fragmented asymmetric tip reconstructed with grafts and defined with fine grafts.