Male hispanic patient complaining of the appearance of his nose and continued nasal obstruction following 3 previous rhinoplasties performed elsewhere.

Procedure: Revision Rhinoplasty (4th) with right ear conchal cartilage graft harvest, chin implant

FINDINGS: Narrow right middle vault with internal valve compromise, over-resected lower lateral cartilage (minimal cartilage present) with external valve collapse on right with alar rim collapse, tip cartilage graft intact (probable cap graft), poor tip projection.

Comments: Overall, his nose is improved following complete reconstruction with composite conchal grafts, spreader grafts, alar batten grafts, infratip lobular grafts and onlay grafts.