Many of my Houston revision rhinoplasty patients present with a twisted or assymetric nasal tip after their previous rhinoplasty. Creating a symmetric and even tip is one of the most difficult aspects of rhinoplasty. With revision rhinoplasty, the tip cartilages can be very twisted and scarred down. This makes these cartilages less malleable and more difficult to reshape. Frequently, the cartilage must be divided and repositioned and/or cartilage grafts used to create a more symmetric and softer nasal tip.