This patient had suffered several nasal fractures while playing basketball. He complained of severe nasal obstruction, particularly on the left. His nose is obviously twisted and he had a severe left nasal septal deviation. We performed an open rhinoplasty to straighten both his external nose and his septum with the goal of improving his breathing. While we greatly improved his breathing, his external nose drifted a little back to the right through the healing process. Variations can occur in the healing process despite our best efforts. We always stress with rhinoplasty that our goal should be improvement, not perfection.