A septal extension graft (SEG) can control nasal tip projection, shape, and rotation. SEG and dorsal alloplastic implants have predominated in Asian rhinoplasty, leading to iatrogenic complications such as a foreshortened nose and destruction of remaining septum. The lower nasal two-thirds can be enhanced anteriorly and caudally using the septal L-strut extension graft in Asians with relatively small noses. The septal L-strut extension graft is indicated in primary cases in which the bony dorsum is acceptable but the cartilaginous dorsum is relatively hypoplastic, and in secondary cases with an iatrogenic short-nose deformity due to alloplastic implants.