42 year old black female from Nebraska requesting a higher bridge, more refined tip and slightly narrower nostrils. The patient also requested an upper lid blepharoplasty to further refine her upper lid area. She also wanted higher cheek bones. This patient had an Open Rhinoplasty with a custom carved silastic implant to raise the bridge and the naso-frontal angle. The tip was reconstructed with using multiple cartilage grafts, a vertical dome division and cephalic strip. The tip was also defatted. The nostrils where narrowed using a horizontal narrowing technique. Her tip projection and rotation where repositioned to a more appropriate aesthetic position. Medium cheek implants were also place through a sub-labial incision and secured using screws. A standard upper lid blepharoplasty was also performed.