The alar cartilages provide the contour and structural support of the nasal tip. Current rhinoplasty concepts support preservation of alar structure with suture techniques or judicious cephalic trim indicated for tip deformities. In many primary cases and some revisions, adequate alar structure exists to achieve the desired aesthetic and functional results with conservative surgical methods. In some primary and most revision cases, however, the existing tip structure is inadequate to create a structurally sound and aesthetically pleasing nasal tip without adding structure. In these cases, alar cartilage grafting techniques are indicated to recapitulate nasal tip contour and structure.