With the high demand of rhinoplasty surgery, careful selection and management of aspirants, as well as proper assessment of outcomes after surgery, is imperative for successful outcome and learning from it. The aim of this study was to answer two important questions: 1. What is the success rate in cosmetic rhinoplasty?, and 2. How best to identify candidates who would achieve good outcomes. In this study group, we excluded patients with any functional concerns, and those confounding factors that could in any way influence the satisfaction from a cosmetic surgery in patient perception. This study is a part of the trilogy of articles on ‘Psychology of Rhinoplasty’ submitted to this volume of Facial Plastic Surgery, using Mandatory Psychiatric Evaluation (MPE) to optimise candidacy. 184 patients (144 female, 40 male) aged 16-63 (M = 31.09) met criteria and were used in this study (follow-up 3-122 months, M = 70.18 months), and outcome satisfaction was assessed using a Visual Analogue Scale (VAS) score and a five-point Likert scale. The mean improvement between pre-operative (M = 4.26) and post-operative VAS scores (M = 8.47) was 4.23. Most patients were happy or very happy (95.1%) about the surgical outcome, where the patients who were very happy generally scored between 8-10 on the VAS (77.2%), and those who were happy generally scoring 6-7.9 (21.2%). Some patients, however, were neutral (3.3%) or unhappy (1.6%) about their surgical outcome, and generally scored around 7 or less on the VAS. The successful outcomes in 95.1% patients reflects a carefully designed protocol for rhinoplasty candidacy, and yet, showed 4.9% with poor satisfaction despite these efforts. An ever present proportion of unhappy outcomes is a reality of this popular surgery.