The best rhinoplasty is one that produces a nose that is proportional and in balance and harmony with the other facial features. This can involve addressing all areas of the nose including: the dorsum (bridge), the boney vault, the tip, and the alar (nostril) base. Not all rhinoplasty patient need to have adjustment to each and every part of the nose -- this is something that needs to be evaluated on a case-by-case basis. Ideally, rhinoplasty is a one time operation -- patient's should not need a second surgery or a touch up if the first one is performed correctly. [ The exception to this is complex secondary (revision) rhinoplasty or nasal reconstruction in which the procedure is planned in several stages. These are unusual cases and doesnt apply to the vast majority of primary (first-time) nose jobs. There are, however, limitations to what rhinoplasty can accomplish. For instance, very large noses or noses with very thick skin can be made somewhat smaller; but in order for the nose to have any shape, the skin must fit tighly around the newly constructed framework. The converse is true for small noses -- the nose can be made larger, but only to the extent that the skin will accomodate the framework.