In a typical open septoplasty, septal cartilage is separated from the upper and lower lateral cartilages, and the deviated central portion of the cartilage is removed, leaving an adequate dorsal and caudal L-strut, typically 1.0 to 1.5 cm wide. We commonly harvest this central septal cartilage for autologous grafting material, but its availability can often be restricted in a severely deviated nose. For a deviated or twisted L-strut, a number of techniques have been described to straighten or stabilize the cartilage, including spreader grafts, scoring incisions, caudal septal repositioning, suture fixation to the nasal spine, and extracorporeal septoplasty for severe cases.1- 6 For a septum that is straight but simply deviated from the midline, repositioning of the caudal septum with or without suture fixation to the nasal spine may be adequate in straightening the L-strut. More complex septal deformities, such as an S- or a C-shaped configuration, may require additional procedures, such as scoring incisions, spreader grafts, or even extracorporeal septoplasty with construction of an L-strut. Despite these numerous adjunctive techniques, correction of a twisted caudal septum without weakening or compromising nasal tip support is often quite challenging.