This patient had undergone a rhinoplasty about 7 years ago. However, she was dissatisfied with her postoperative asymmetry and increased columellar show (one can see an excessive amount of the nostril on profile view). The patient had an overprojected tip with a residual fullness to her bridge.... She also had collapse of her left middle nasal vault. I performed a revision rhinoplasty using the patient’s septal cartilage. I was able to improve the tip projection, columellar show and middle third collapse while at the same time creating a more pleasing bridge line. After decreasing the patient’s tip projection, her nostrils became excessively flared so I also performed an alar base excision by removing a small piece of tissue from the floor of the nostrils. The patient is shown about 3 months postoperatively and has expected residual tissue swelling, mainly of the nasal tip, that will continue to resolve over time.