32-year-old male presenting today in consultation regarding aesthetic nasal concerns. Patient desires dorsal hump reduction, tip refinement. Dr. Barrera performed a Primary cosmetic preservation septorhinoplasty with septal cartilage grafting (left SEG). A modified through and through dorsal cartilage z plasty incision was performed along with an osteotomy through the perpendicular plate of the ethmoid bone to allow for let down of the dorsal hump. At this point, the nasal dorsum was fully let down. A 5-0 prolene was placed around the excised septal cartilage segment to hold the let down dorsal hump in position. An inferior oblique incision is then carried caudally through to the anterior septal angle to level of cartilaginous dorsum. Inferior septal cartilage was harvested in one piece with care taken to maintain greater than 1.5 cm L strut. The anterior left upper lateral cartilage was released from the septum. Cephalic trims were performed leaving 8mm wide lower lateral cartilages and releasing the scroll. 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.