In this patient, the nose as a whole appears somewhat “heavy” relative to the face. The skin is thick. The aesthetic lines of the dorsum are not regular, the tip lacks definition, and the nasolabial angle is too open (meaning that, although the nose is “heavy,” it also appears somewhat short). In profile, a modest dorsal hump is evident. This is essentially a “refinement” rhinoplasty requiring multiple fine, precise, almost millimetric adjustments. The patient wishes to refine her nose with a result that is as harmonious as possible and that does not appear operated. This objective of “refinement” is achievable only to a certain extent with thick skin, because while thick skin avoids the risk—associated with thin skin—of revealing every minor underlying imperfection, it tends to cause the opposite problem: masking (due to its thickness) the underlying definition. For this reason as well, preoperative computer simulation is essential and must take into account the characteristics of the skin, to be reviewed and discussed with the patient. In that simulation, it will be possible to agree together on the height of the dorsum and the degree of tip–dorsum “break.”