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This 21 year-old lady underwent open precision rhinoplasty to feminise the side profile and straighten a crooked nose. An ultrasonic technique was used for accurate bone reshaping and auto-spreader flaps to optimise breathing. Various manoeuvres were performed to straighten the nose (septoplasty, scoring, asymmetric sutures) – often the most challenging aspect of rhinoplasty as well as deliver greater tip refinement. Result at 6 months