Mrs. F had a previous Rhinoplasty done many years ago but still had significant nasal breathing obstruction. While she was unhappy with her nose, she did not want a very extensive revision procedure. Due to previous septal cartilage removal, ear cartilage was needed to reconstruct her nose. Her goals were to narrow the nose, make it work better, and improve her profile. A left spreader graft was placed. Profile polishing and shaving was done as well. Derotation was achieved using an onlay tip cartilage graft. This also provided narrowing of the front view. The result is a dramatic improvement in the nose without complicated surgery. This was performed using a closed approach.