The present study included 120 patients (79 males and 41 females), with a mean age of 29½ years (age range, 16-58 years). Caudal septal cartilage deficiency was present in all cases and was associated with premaxillary bone loss in 93 cases (77.5%). Of the 120 cases, 90 (75%) were revision cases involving patients who had previously undergone 1 or more rhinoplastic or septal surgical procedures and 30 (25%) were primary cases. In more than 90% (n = 82) of the revision cases, the caudal septal and premaxillary deficiencies resulted directly from previous resections (Figure 3), and in fewer than 10% (n = 8) of the revision cases, the surgery was complicated by septal hematoma and abscess formation that destroyed the caudal septal cartilage (Figure 4). In 18 of the 30 primary cases (60%), the caudal septal and premaxillary deficiencies resulted from crushing injuries, and in the remaining 12 cases (40%), the deficiency resulted from a congenitally weak underdeveloped caudal septum and premaxilla. Of the 12 cases, 8 involved flat “negroid” noses, and 4 were Binder syndrome (Figure 5). All patients had external nasal deformities, related to the loss of caudal septal and premaxillary support, in the form of a depressed, droopy nasal tip with an acute nasolabial angle, a retrodisplaced nasolabial junction, a posteriorly inclined upper lip, and a hidden posterior columella. Also, 86 patients (71.7%) had nasal obstruction that was caused by the depressed, droopy nasal tip. A cartilaginous caudal septum replacement graft was used in all 120 patients, and it was combined with premaxillary augmentation with Mersilene mesh in 93 patients (77.5%). The graft was made of autogenous septal cartilage in 63 patients (52.5%), autogenous conchal cartilage in 30 patients (25%), and irradiated costal cartilage homograft in 27 patients (22.5%). All patients received periodic follow-up care for a mean period of 3 years (range, 1-12 years), during which subjective assessment of the outcome of the surgical procedure was performed by clinical examination, by comparison of preoperative and postoperative photographs, and by recording the degree of the patients' satisfaction with their aesthetic and functional results. The CSR graft and premaxillary augmentation corrected the external aesthetic deformities in all cases and provided an excellent amount of support to the nasal tip, allowing it to maintain its position over the long-term follow-up period, with no loss in the degree of projection or rotation achieved. No cases of infection, displacement, or extrusion were encountered during the follow-up period. Functionally, 74 patients (86%) with preoperative nasal obstruction reported a marked improvement in breathing, and 12 patients (14%) reported no noticeable change in breathing.