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This patient had a desire to make her nose "prettier." The nose had a downward pointing tip with a dorsal hump. The nose needed reduction of the hump, rotation of the nasal tip upward, and refinement of the nasal tip. A columella strut was used for tip support, osteotomies were used to narrow the nose, interdomal, and hemidomal sutures were used to refine the tip. To rotate the tip, and improve the columella labial angle, a caudal trim of the septal cartilage was performed as well.