Primary surgery candidate with a deviated septum, deviated columella cartilage and nasal spur. Goals: 1. maximize airflow, particularly to the deviated portion. (L strut septoplasty?) 2. Straighten columella cartilage. (columellar extension graft?) 3. Columella tissue obstructing deviated portion edge of nose. (Stitch tissue?) 4. Remove nasal spur.(Surgical excision?) Current ENT can only offer a closed septoplasty. Septorhinoplasty? Is my case that difficult to fix right the first time?