A 19 year-old patient, who had a previous rhinoplasty which left him with an over-projecting elongated nasal tip, drooping tip, thick tip skin with extreme bulk, and a bulbous tip. He is now 9 months post-op from revision rhinoplasty with nasal tip refinement, nasal tip deprojection to shorten the overall length of his nose, tip elevation, and placement of a columellar strut graft and spreader grafts using MTF cartilage to add tip support and improve his breathing. A mastoid fascia tip graft was also used to unify and refine the tip. There is still tip swelling which generally takes at least 1.5 years to fully resolve. The overall goal is a conservative change to the nose for a natural looking result which still retains a masculine appearance of the nose.