33-year-old female presenting with a cartilagenous dorsal hump and tip ptosis. Dr. Barrera performed a Dorsal Preservation cosmetic rhinoplasty with placement of SEG, crushed cartilage and nasal SMAS supratip graft. Cephalic trims were performed leaving 8mm wide lower lateral cartilages. A septal extension graft was fashioned from the harvested septal cartilage and secured to the maxillary crest and left side of the native septum with 4-0 PDS and 5-0 prolene. 5-0 prolene dome spanning and lateral crural tensioning sutures were placed to create new domes and increase rotation, securing the lower lateral cartilages to the septal extension graft. The skin was elevated off the medial crura. A tongue-and-groove procedure was performed and the medial crura were sutured to the caudal septum with 5-0 prolene. Medial crural fixation sutures were placed to secure the medial crura together and narrow the columella. Crushed cartilage and an attached nasal SMAS flap were positioned to support the supratip region.