An upturned nose is very common among patients undergoing rhinoplasty, particularly in the local population where a face shape of southern ethnicity is common, accounting for approximately 20% of all patients. Although there is no definition of an upturned nose in medicine, an obvious upturned nose symptom indicates the connection between the nostril and nasal tip slanted upward by over 30°, the angle between the nasal columella and upper palate of over 110°, or the frontal exposure of the nostrils over two-thirds of the overall nostrils. This problem mainly results from congenital or hereditary nasal tip cartilage hypoplasia or upward retraction of the exceedingly tense nasal tip skin and subcutaneous ligament. Severe patients may even have aplasia or defects of the nasal septal cartilage. Therefore, abundant autologous cartilage should be transplanted for correction. Dr. Chuang employs both the nasal septum and auricular cartilage and utilizes the nasal septal cartilage firstly to elongate the nasal columella and then the auricular cartilage to augment and extend the nasal tip. This practice simultaneously elongates the nasal supratip and nasal columella and extends bilateral alar margins downward to conceal the nostrils. Generally, if the frontal nostril exposure can be concealed by one-half or even two-thirds, it amounts to a successful correction. If the nasal septal and auricular cartilage cannot fulfill the correction objective upon evaluation by Dr. Chuang, autologous or homogeneous costal cartilage (allograft) can also be applied. Nevertheless, attention should be paid to the tightness and tolerance of the patient’s skin on the elongation of nasal tip cartilage, or it is likely to cause an exceedingly thin skin or poor healing of an intranasal wound. Therefore, if the patient manifested poor skin conditions at the nasal tip, autologous fascial transplantation (dermal fat graft) for nasal padding will be necessary to prevent an exceedingly pointed nasal tip or visible cartilage shadows. Moreover, because patients with an upturned nose mostly have a very flat nasal bridge, concurrent open rhinoplasty and alar reduction should be considered to improve the appearance of the whole nose at one time.