This is an 18 year old young woman in good health. She is 5’8” and 135lbs. Her only previous surgery was for her wisdom teeth. Since she was very young she has had a very large nose with a significant dorsal deformity and overhang. The nose is also a bit too long for her face and required more tip definition. Having discussed the risks, benefits and alternatives of surgery at length she chose to proceed with an open rhinoplasty in which the dorsal hump was removed, the tip was elevated and the nose was shortened. At the same time she had a gentle tipplasty to improve the tip presentation. Her postoperative course was completely unremarkable. Photos obtained at two months demonstrate that she has achieved her desired result. The nose is smaller with better definition and without the dorsal hump and overhang. She is back to all activities. Her breathing is normal and she and her family are quite pleased with her surgical outcome.