45 year old African American male patient who presented with a broad lower nasal third and low flat dorsum. He sought elevation of the bridge and naso-frontal angle with narrowing of the nostrils with enhancement of the tip. Open Rhinoplasty Surgery was performed with custom carved SLUPimplant™ placement to elevate the dorsum and also enhance the bridge. Additionally, bilateral osteotomies decreased bridge width. Nasal Refining Surgery included defatting of the nasal tissue and placement of Cartilage Strut and Shield Grafts to refine and define the tip. The patient also requested nostril narrowing, which was performed via a vertical and horizontal nasal narrowing technique.