Our modern approach to rhinoplasty in Boston relies on reshaping the nasal cartilages without compromising the support. Only observation of these two goals will lead to an improved but normal looking nasal tip. Most of these rhinoplasty procedures we perform with the endonasal approach avoiding external nasal skin incisions. The pinched and “unusual” look needs to be avoided at all cost. Most patients who are seeking revision rhinoplasty had their procedures performed decades ago when much of the important cartilage was removed. This leads to pinched and collapsed noses and usually also interfers with nasal breathing making complex reconstructive rhinoplasty procedures necessary.