Rhinoplasty, or nose reshaping, is a very effective way to improve facial aesthetics. A procedure to lower the dorsum (hump), trim and define the tip , straighten the crooked, or narrow the wide (or widen the narrow, for that matter) can do wonders to balance the central feature of the face. Rhinoplasty works best when the surgeon respects the boundaries of nasal anatomy – in effect, taking what the defense gives you (for the sports fans). This way, the patient still looks like themselves, only better. Disasters can happen when the surgeon tries to make the nose do something it was not meant to do or when making changes that do not match the rest of the face. When the surgeon respects anatomic boundaries, he or she is often respecting ethnicity as well. A narrow turned up nose does not look right on a broad flat face. Thinner skin will not allow the same manipulation as thicker skin. The list goes on. It is the surgeon’s job to listen to what the patient wants, assess for realistic expectations and feasibility, and design a safe and predictable operation to meet those goals. A specific discussion of the patient’s desired changes in the context of his or her ethnicity is an important component of the consult. As they say, a picture is worth a thousand words. To that end, I have found my VECTRA 3-D Imaging System to be invaluable when making sure my interpretation of what the patient wants matches his or her expectations. See the August Case of the Month for an example of rhinoplasty respecting anatomy and ethnicity.