In addition to airway obstruction, crookedness of the dorsal septum or asymmetries of the upper lateral cartilages can cause contour deformities of the middle third of the nose.2, 5-6 A variety of techniques have been described to address this, including septal modifications, crossbar and camouflage grafts, and splinting of the septum with autologous or synthetic materials.2, 6-8 Reconstruction of the anterior septum with a traditional septoplasty approach is limited by risks to tip support should overresection or overweakening of the cartilage occur. Furthermore, anterior septal deviations, particularly if high on the septum, are often accompanied by a narrow valve angle. For cases of severe septal deviation, extracorporeal septoplasty has been advocated.9-13 One drawback of this technique is destabilization of the junction of the quadrangular cartilage and nasal bones (keystone area), with resultant requirement for unique forms of fixation, such as percutaneous sutures, or sutures to the ethmoid or nasal bones. In cases where destabilization occurs, notching or saddling of the dorsum can occur.10, 12 To minimize destabilization of the keystone (and thus preserve dorsal contour), I have sought to modify extracorporeal septoplasty by preserving the dorsal septum. Anterior septal reconstruction (ASR) is a more conservative approach to extracorporeal septoplasty that preserves dorsal support, designed to concomitantly address nasal obstruction and the external contour deformities.