23 year old male who came to Dr. Slupchynskyj because he was not happy with results from a previous Rhinoplasty with another surgeon. The patient wanted a higher nasal bridge, tip refinement and a narrowing of his nostril width. Open Rhinoplasty Surgery was performed where a custom carved silastic implant was placed to augment the nasal bridge. Bilateral osteotomies were performed to further narrow and redefine the bridge. Nasal Tip Surgery included a defatting of the tip, use of cartilage strut and shield grafts to further refine the tip and a vertical nostril narrowing technique to reduce nostril width. Post- operatively, this patient is very happy with the results he initially wanted but did not get with another surgeon.