This young patient primarily complained of a significant post-traumatic torsional deformity of the dorsum and tip. This was accompanied by marked breathing impairment, clearly visible on CT. The procedure consisted of wide exposure of all structures, asymmetric mobilization of the nasal bones, midline reconstruction of the nasal septum, tip reshaping, and reduction of the width of the nasal alae. As is often required in cases of multiple, significant septal deformities, the septoplasty required an extracorporeal reconstruction. The symmetrization and contouring of the nasal bones were greatly facilitated by the use of new piezoelectric instrumentation (differential osteotomies and osteoplastic maneuvers performed with ultrasonic tools).