Many patients have a drooping tip for which they seek out a rhinoplasty to be able to lift their tip on a permanent basis. Most patients are simply born with a droopy tip, and it is usually not related to trauma. As a surgeon, it’s important to evaluate the nose anatomy to determine what is causing the droopy tip. Some patients have angulated nasal tip cartilages, which are pointing downwards which must be lifted up with a combination of suture techniques and conservative cartilage removal. Sometimes the lower lateral cartilages need to be sewn to the upper lateral cartilages to stabilize them. Cartilage grafts such as a columellar strut graft can accomplish lifting and supporting the nasal tip. Cartilage grafts are harvested from inside the nasal septum, are fashioned to the appropriate size and shape, and are inserted through a precise pocket to give structural support to the nose. It’s also important to make sure the new tip balances with the existing nasal bridge line so that the nose is not out of balance.  A full rhinoplasty is usually required when lifting a droopy tip. Most patients who have a droopy tip also have a dorsal hump, so the dorsal hump must also be addressed by shaving it down as well. It is also important to evaluate the presence of the depressor septi ligament. If the depressor septi ligament is present in some individuals, it pulls the tip down with animation and smiling. Releasing of the depressor septi ligament prevents the tip from drooping with animation and talking. This also helps prevent the ligament from pulling the tip down in the postoperative period. The nasal tip cartilages also have to be addressed as far as narrowing or widening them, depending upon their pre-existing condition. Many droopy tips are also bulbous and lacked adequate tip support, therefore need to be lifted, supported and narrowed simultaneously. William A. Portuese, M.D. performs rhinoplasty to lift the droopy tip with a closed rhinoplasty approach. The procedure is performed under general anesthesia by a board-certified physician anesthesiologist in attendance throughout the entire procedure