In this unique publication authored by a plastic surgeon, several cosmetic issues surrounding Pectus Excavatum (PE) repair are considered. Repair does not always result in optimal cosmetic appearance. Sometimes, concave areas on either side of the chest can develop after surgery, for instance. Affected individuals should not quickly jump to having repeat surgery. In this article, the plastic surgeon highlights that there are many different techniques to address the remaining suboptimal cosmetic apperaance of PE repair. PE patients who have a primary goal of achieving cosmetic improvement should consider consulting a plastic surgeon with expertise in PE. Among these are various shaping and reconstructive techniques with costal cartilage manipulation.