Mrs. B. had significant functional breathing obstruction and was concerned with crookedness and a profile bump. A closed septoplasty and rhinoplasty (profile-predominant) was performed. Bilateral spreader grafts (thicker on the left) was done for straightening of the midsection of the nose and to assist in smoothing out the nasal sidewalls. The bumps and width of the bridge on frontal view were a particular concern for this patient. Tip cartilage volume was reduced and several structural tip grafts (columellar strut, shield, and right rim) were placed in order to provide long term structure and make the overall result harmonious.