From the point of view of the clinical psychologist, one important dimension of the psychological experience of the typical cosmetic rhinoplasty (CR) patient that has been underemphasized in the psychological and plastic surgery literature is the patient's narcissism. The author's aim is to facilitate the plastic surgeon's understanding and management of these patients by putting the disparate aspects of their behaviour into a unifying theoretical framework. A total of 41 CR patients from the UK, who had been referred through the National Health Service, were interviewed, psychologically tested and clinically assessed at varying times before and after surgery. A control group of patients undergoing wisdom teeth extractions were also interviewed and tested. The CR patient's narcissism was manifest, for example, in their self-absorption, inadequate self-esteem and fantasies of ideal beauty which was observed in his/her pre- and postoperative behaviour. Some suggestions on the management of the CR patient with narcissistic problems are offered to surgeons and hospital staff in order to maximize the clearly beneficial psychological and behavioural effects of CR.