This young woman particularly disliked the shape and size of the tip of her nose. She felt it was too large and bulbous. She was noted to have very thick skin with large deep pores. This often limits how much change a rhinoplasty surgeon can achieve as the thick skin covers up the refinements made by the plastic surgeon to the nasal framework. She underwent an external approach septorhinoplasty. Aggressive changes were made to underlying nasal framework in order for the the change to be visible through her thick skin. One can see that the tip is narrower and more defined. From below the tip now has a more attractive triangular shape. Form the side view the tip seems to be slightly more projected. This is necessary in order to achieve the definition seen from the front. Dr Rival believes the frontal view is always the most important view when reconstructing a nose. This patient also had alar base reduction or narrowing. A wedge of skin is taken from the sides of the nostrils and is then resutured. This effectively narrows the nostrils or the alar base of the nose in medical terms. The incisions from nostril narrowing generally heal very well. Patients with darker skin often worry about the risk of keloid scars (dark thick scars) however these are extremely rare in this area.