Mrs. H came to Dr. Westreich after 2 previous rhinoplasties with functional breathing issues as well as concern for her nasal appearance. She was informed that some aspects of her previous surgery (medpore impants in the tip) could not be removed. An individual procedure was tailored for her issues, including dorsal cartilage grafting, nasal bone out-fracture, and left spreader grafting. This was done through a closed approach in order to avoid disturbing her medpore implants. Her nose looks natural for the first time in years and she is ecstatic about her functional result.