In this patient, both the tip and the dorsum are asymmetric and deviated, and the cartilages are visible through the thin skin. In the profile view, the radix is depressed and the tip is inadequately supported. It is evident that in this case a “standard” rhinoplasty consisting of dorsal hump removal and surgical osteotomies would be entirely insufficient. Instead, this requires a meticulous structural rhinoseptoplasty, redistributing elements removed from areas of excess and adding cartilage and fascia grafts where needed. The open approach is indispensable in this sense, given the optimal visualization it provides and the ability to position thin, invisible grafts beneath the skin exactly where required. The procedure is certainly longer and considerably more sophisticated, yet the blood loss is virtually negligible. Postoperative pain is absent, and the results remain stable over time.