In this young man, there is a clear rightward deviation, an osteocartilaginous nasal hump, and a bulbous, downward-curving tip (“drooping tip”). Obviously, a standard rhinoplasty involving only hump reduction and osteotomies would not be sufficient. In fact, if that approach were used, the result would be an even more curved nose. Instead, the dorsal hump must be reduced in a controlled manner—leaving it, if anything, just slightly irregular—and the tip must be adequately supported. The patient desires a natural-appearing, “masculine” nose of appropriate length. Given his thick, relatively inelastic skin, it is not possible to reduce the nose excessively without risking both a concave dorsum and an excess of soft tissue at the tip (which would not redrape well over an excessively reduced osteocartilaginous framework). This could lead to a saddle deformity and a pollybeak—complications unfortunately seen all too often in secondary rhinoplasty.