This young lady from North Carolina is an example of a truly beautiful face that was overshadowed by the imperfections of her nose. After her shape was changed in a very natural way, her true beauty was even more noticeable. She is also an example of how grafting is so extremely important in rhinoplasty today. The bridge of her nose was kept high while completely getting rid of the hump. This approach led to a more elegant look and better breathing long term. During our thorough discussion prior to her open rhinoplasty, we had a list of maneuvers numbering almost ten. Included was straightening her nose because her tip was off to the right. Also, her columella was raised so that it would not hang down when viewed from the side. With some changes, I place a dot on the patient’s forehead in surgery which allows careful measurement with a calipher so just the right amount of rotation can be accomplished. There was a tendency for her nostril to arch upward. This was addressed with another type of graft called an extended alar contour graft, which took some of the arching. It has further advantages for the rest of her life. Many rhinoplasty patients have a tendency over the years to have the nostril margin arch up, showing more inside the nose. But with such an alar contour graft, her arch will never raise up and she will always have a natural, youthful shape to that part of her nose. These techniques using grafting technology do take longer in surgery, but it is worth the extra effort for more control of the result. She is extremely happy with her rhinoplasty at only 4 months. Clearly there is still swelling, and the tip shape will continue to improve for another year.