Angiolipoma is a rare, benign variant of lipoma; its distinctive feature is its prominent vascularity. It presents as a subcutaneous nodule of white adipose tissue; pain, which may be exacerbated by pressure, is the chief symptom. The anatomic distribution predominantly involves the trunk and extremities. Because of the rarity of this condition in otorhinolaryngology, our understanding of its diagnosis, treatment, and follow-up is limited. Microscopically, two different histopathologic forms of angiolipomas exist: circumscribed and infiltrating. The diagnosis of angiolipoma can be aided by ultrasound, computed tomography, or magnetic resonance imaging. Surgical excision remains the treatment of choice. Sites of previously reported otolaryngologic cases include the cheek, palate, mandible, nasal septum, and cervical area. We describe what we believe to be the second case of a nasal tip angiolipoma in a 78-year-old woman complaining of progressive aesthetic deformity.