Congenital absence of the lower lateral nasal cartilage is rare. The authors discuss correcting the absence using an open approach technique to harvest septal cartilage. This is then fashioned into a shield graft and a supporting strut graft to define the nasal tip in a better manner. Lateral osteotomies were then performed to narrow the nose and close any roof deformity. Whilst this appears to be a successful operation for a rare condition, the technique could potentially be used following trauma or skin cancer surgery for invasive tumours in that area of the nose.