A 21 year-old lady underwent open ultrasonic rhinoplasty to feminise the nasal appearance and optimise nasal function. A combination of techniques was used to correct the underlying septal deviation and feminise the side profile. Use of ultrasonic bone reshaping help delivered a smooth dorsal contour and reduce post-operative swelling. The deviation was corrected using a wafer thin buttress of bone taken from the septum – to avoid widening the nose from the front. Refinement from the front and the side are apparent at 3 months.