I recently did surgery on a 42 year old man who had 3 previous rhinoplasty procedures that did not turn out the way he had hoped. His rhinoplasty history all began after he had a sports related injury to his nose that affected his breathing. The first surgery made his breathing even worse and from there each surgery not only worsened his breathing but made his appearance worse as well. This was a very difficult surgery and I knew it would be. I had to use his rib cartilage to rebuild his nose. This was a 6 hour surgery that was extremely complex. The trick to this surgery was to completely restructure and rebuild his nose all while making only a minimal change to his appearance. He is now 3 weeks out from his surgery and is still swollen but the cosmetic improvements are exactly what we set out to achieve and his breathing is dramatically improved.