The correction of alar columellar disharmony can be very challenging and is often neglected during rhinoplasty. Failure to address alar columellar disharmony may adversely affect an otherwise satisfactory outcome. The tongue-in-groove suture technique has been described in the literature using an open approach as an effective surgical maneuver to assist in correcting this deformity. The endonasal approach in rhinoplasty has the advantage over the external approach of preserving greater nasal tip support. Herein, I highlight the tongue-in-groove suture technique using the endonasal approach in primary rhinoplasty as an effective long-term tool for correcting alar-columellar disharmony caused by the hanging columella in conjunction with other variant anatomy.