Background <p>East Asian patients with unilateral cleft lip and nasal deformity (UCLND) have severe septal deviated. An innovated septal reconstruction method using both perpendicular plate of ethmoid (PPE) and cartilage septum may improve ventilation and achieve similar aesthetic improvements as septal reconstruction using costal cartilage.</p> Methods <p>Patients with UCLND who underwent septal reconstruction using PPE or costal cartilage in the same period were retrospectively included in a 1:1 ratio. Comparison of preoperative and postoperative differences in NOSE and ROE scales and changes in scores between the two groups were made. Changes in nasal airway morphology and ventilatory function were analyzed using computational fluid dynamics in a case using PPE.</p> Results <p>A total of 24 patients were included for analysis. Patients undergoing septal reconstruction using PPE showed significant improvement in NOSE scores and ROE scores. The improvement in ROE scores was similar to patients undergoing septal reconstruction using costal cartilage. Computational fluid dynamics analysis showed that septal reconstruction using PPE improved the patient’s bilateral nasal airway morphology and flow symmetry.</p> Conclusions <p>The combined application of PPE and septal cartilage to reconstruct the nasal septum in East Asian patients with UCLND is effective to improve the ventilation function and nasal airway symmetry. This strategy can achieve aesthetically similar results to septal reconstruction using costal cartilage.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>