Hossam M.T. Foda, MD, discusses a retrospective series of 120 patients who presented for rhinoplasty to correct the aesthetic and functional problems resulting from loss of the caudal septal and premaxillary support. In most cases, the caudal septal deficiencies followed previous surgical excisions. An external rhinoplasty approach was used in all cases. The lost nasal tip support was reconstructed using a cartilaginous caudal septum replacement graft that was combined with premaxillary augmentation using a roll of Mersilene mesh, which improved the support and stability of the graft. The technique used provided excellent support to the nasal tip, allowing it to maintain its position over the long-term follow-up (1-12 years). No cases of infection, displacement, or extrusion were encountered. The surgical technique is described in detail, and the impressive operative results are well illustrated.