Mrs. M had significant nasal obstruction and concerns about her profile bump and crookedness. A combined functional and cosmetic procedure was done using a closed rhinoplasty approach. A profile-plasty with tip volume reduction and a right spreader graft was performed. The length of the septum was reduced and the tip cartilages were sewn onto the septum (tongue in groove technique) in order to improve her nostril appearance from the side and open up her nostrils by narrowing the columella (see base view). Foundation rhinoplasty techniques (subalar graft and osteotomies) were used to straighten her nose as well. The result is a balanced nose which breathes well and also looks natural.