This American patient from Boston had a threatening car accident about 20 years ago. In the car accident the patient suffered nasal obstruction, skin injury and severe dislocation of the nasal bone and fragmentation. He has done 2 rhinoplasty surgeries in the past without any success. Here we used ear cartilage to improve his nose. Also he was suffering from adhesion and septal necrosis. The final results elicited a satisfactory post operative results due to his prior conditions.