Figure 2: (a) Reflection of mucoperiosteal flap, turn over flap along the cleft margins then closure of the nasal layer. (b) placement of the bone graft in the defect and fixation of the graft with screw to support the alar base. (c) open rhinoplasty incision and exposure of the nasal septum, correction of septal deviation, harvesting septal cartilage graft, z-plasty incision at the left alar base and upper lip and dissection of the different layers of the lip and nose. (d) septal cartilage graft 15 mm × 20 mm. (e) part of septal cartilage graft used as a collumellar strut. (f) suturing of the skin.