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Preop and 6 months post op photos. This is a 44 yo female who presented with concerns of a significantly flattened tip with a widened alar base. She also felt that her nasal dorsum was too flat and wide. She underwent rhinoplasty with complete reconstruction of her lower alar cartilages with ear cartilage grafts in order to create a new nasal tip. In addition, her alar base was narrowed by performing alar wedge resections and placing a trans-alar cinching suture. Finally, her dorsum was narrowed by performing osteotomies with nasal bone infracture.