Patient presented for evaluation for treatment of complications arising from previous rhinoplasty. Patient had dorsal augmentation rhinoplasty with silicone implant some time ago (another surgeon) but patient started having issues with the implant. The implant became deviated, contracted, and was about to come through the skin (threatened exposure). As such, I recommended that the implant be removed and that she undergo an autologous secondary rhinoplasty. As such, patient underwent open rhinoplasty with removal of silicone implant followed by dorsal augmentation using dermis-fat graft and tip modification with ear cartilage graft. Dermis-fat graft uses skin and fat layer from your hip area in place of a dorsal implant. In older patients the quality of rib cartilage is not very good so dermis-fat graft can be a better option. The donor site is well concealed and the height of the nose can be adjusted easily during the surgery. A revision rhinoplasty is much more complex and difficult than a primary (first-time) rhinoplasty. The skin is scarred in and the tissue does not move as much. In addition, the soft tissue is harder to control. However, she achieved a good result whereby she maintained her dorsal height and improved tip projection using her own tissue.