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This 27 year-old lady underwent an ultrasonic rhinoplasty to deliver a more feminise profile. Modest changes were made to various aspects of the nose – bridge height, tip rotation, base width. This patient had relatively thick skin on the tip of the nose, which is a common issue amongst patients and can restrict the degree of tip definition that can be created. However, with special manoeuvres including defatting of the tip skin and strategic use of tip cartilage grafts (from the septum), a significant change was achieved even at this early stage in the recovery process. At 2 months, she was delighted with the outcome and improved confidence.