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Mr V had severe nasal obstruction and was concerned with his profile appearance and nasal deviation. He was given several options for his surgery but elected to skip formal tip surgery. A combined functional and cosmetic procedure was done using a closed rhinoplasty approach. A profile-plasty with left tip cartilage reduction, a left spreader graft, and a supporting tip graft was done. Foundation Rhinoplasty techniques were used to help straighten the upper nose and move the tip towards the midline. He is currently very happy with the outcome and is considering tip surgery for further refinement and straightening. This case illustrates how powerful Foundation Rhinoplasty interventions can be in straightening a severely crooked nose. Since tip surgery was not performed during the initial operation, if Mr. V decides to have it done, it would not be considered a revision, merely a completion procedure which will behave surgically much like a primary Rhinoplasty.