I tried direct flash and the lighting was horrid and harsh with deep shadows cast on the wall behind. I couldn't really mix flash and ambient because the background lighting was so low.
Solution? Tape a sheet of A4 paper around the flashgun and use that to soften the light. Lighting softness is dependent on the effective size of the light - by bouncing off the paper, the light gets softer. As you'll see in future posts I could position the light to get different effects as well!
The result is some nice soft shadows around the nose and on the background. I removed some of the saturation to give a colder feel to the shot.
FUJIFILM FinePix X100, f/4 @ 23 mm, 1/1000, ISO 400, Flash