Mrs. T 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 a structural graft to the tip (columellar strut) and a right spreader graft was performed. 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.