25-34 year old female with a history of a cleft lip and palate who has had numerous surgeries of the nose to improve the size, shape, symmetry and function. The patient was most concerned about the c-shape deviation, bulbous tip and left alar retraction. She wanted to improve the asymmetries of the lip, the under-projected and over-rotated nasal tip, and the flatness of the midface and left alar facial groove. The patient underwent a cleft revision rhinoplasty with rib cartilage graft and fat transfer to her lips and midface. In the post-operative photos, you can visualize an improvement in the contour and proportions of the dorsum and nasal tip. The nose is straighter, the tip is projected, and de-rotated, and the alar retraction is improved.