The objectives of septorhinoplasty surgery are usually to improve the shape of the nose, improve breathing through the nose or both and the surgery encompasses a variety of techniques. It is vital to remember that the structure and function of the nose are intimately related and that structure and function both need to be preserved. It should also be remembered that the healing process goes on for many years and the aim is long term stability without the problems that can come with contraction of the skin envelope and the cartilage and soft tissue changes that can occur with time. I bring this in at the start of this editorial as often these factors are not considered. For the purpose of this editorial, I will concentrate on those patients who are undergoing surgery that will change the shape of their nose and thus their appearance. Patient selection is extremely important in rhinoplasty. This is both to ensure that the patient is suitable for surgery and will be satisfied with the results of surgery and as I will discuss later in this article, it is also important that the surgeon protects himself by avoiding surgery on the unstable patient.