Most plastic surgeons will agree that to truly perform correctly, rhinoplasty is the most challenging plastic surgery procedure. It essentially involves the sculpting of cartilage and bone so that enough is done to these support structures but at the same time not too much so that the support of the nose is weakened and then the overlying skin is expected to heal over the bone and cartilage to create the desired results. Any plastic surgeon can perform a basic rhinoplasty; however, the aesthetic results may not be achieved unless the surgeon is truly experienced in all the different maneuvers. Approximately one-third of the rhinoplasties I perform are revision procedures. The most common reasons for the patient desiring these procedures are the over-resection or the under-resection of cartilage and bone that results in the patient having scooped out appearances, asymmetric tips, or residual bumps whether of the bone or, more commonly, the cartilage. Other indications include nasal bridges that were not broadened or were not narrowed enough and perhaps were not even set in, asymmetry of the tip and middle of the nose, difficulty breathing due to inadequate septal work or loss of support of the nose, under projected and/or very weak tips, tips that were either rotated too high up or were left hanging down, and noses that remain crooked or that are crooked as a result of the surgery. There are a variety of advanced techniques that are used in revision rhinoplasty that allow for significant improvement in aesthetic appearances as well as the function of the nose.