This 34 year old patient was dissatisfied with the hump on her nose and felt that the tip of her nose plunged downwards,... giving her nose a hooked appearance. In addition, her nose was pinched in the middle vault, just below the ends of the nasal bones. An open rhinoplasty was performed. Her hump was removed and lateral osteotomies were performed to prevent an "open-roof" deformity. Cartilage was harvested from her septum. Spreader grafts were placed to widen the middle vault, improving her nasal airway. A columellar strut was placed to support her tip and a septocolumellar suture was used to increase rotation and tip projection. The "after" photos were taken 5 months following surgery.