This 24 year old female disliked her dorsal nasal hump. The projection and height of her nose were out of balance with her other facial features. She has very thin nasal skin globally. She also had a wide and retracted columella. She was treated with an open rhinoplasty, dorsal hump reduction, tip support and narrowing of the columella. Her trans-columellar scar is invisible, just seven months after surgery. From every angle, she is delighted with her post operative result, photographed several months after her surgery with the rhinoplasty surgeons at Sound Plastic Surgery in Seattle.