A 21 year-old lady underwent open rhinoplasty to feminise the side profile and correct an underlying asymmetry (deviation to the right). An ultrasonic technique was used for accurate bone reshaping and to reduce post-operative bruising/ swelling. Auto-spreader grafts were used to optimise nasal function and tip refinement was achieved with a combination of suture and cartilage graft techniques (septal extension, alar baton grafts). She also underwent simultaneous breast augmentation – a common combination of procedures in my practice. At 4 months, she was delighted with the soft natural look and improved self-confidence.