30 year old Richmond rhinoplasty patient who underwent an open rhinoplasty to correct very retracted, asymmetric nostrils.  She had a convex profile due mostly to cephalically oriented lower lateral cartilages.  This is a situation in which the tip cartilages are angled upward instead of outward causing upward arching of the nostrils and fullness above the tip.  This case required very advanced techniques to reposition the cartilage in a more favorable orientation.