Challenging primary rhinoplasty female patient who presented with nasal blockage and cosmetic complaints regarding her nose. She found her nose to be large and with a crooked appearance. She was found to have a significantly deviated septum and an external deviation of her nose to the right side. Complicated primary rhinoplasty which included a septoplasty, placement of spreader grafts, removal of nasal hump, tip setback through a tongue and groove technique, and tip domal suturing. Postoperatively, patient now without nasal breathing problems, nose straight externally, profile alignment with straight dorsum, and natural tip refinements on frontal view. Base view demonstrates the tip refinements achieved while maintaining nostril symmetry.