This patient underwent a cosmetic rhinoplasty 7 months ago. Her main concerns were her bulbous tip /thick skin, depression of her right bridge and wide nasal bridge. The nasal bridge was addressed with lateral and medial osteotomies. The depression of the right upper lateral cartilage was addressed with a right cartilaginous spreader graft. The bulbous tip was addressed with a triple tier tip technique, tongue and groove technique to address the medial crura and an extended tip graft. The ultimate appearance of a patient with thick nasal skin is achieved by creating a sound nasal framework to support the thick skin.