In a contracted nose, the septal L-strut is a critical structure. The apparent reason for the severe constriction, rarely seen in Western rhinoplasty but common in Asian secondary cases, lies in the loss of septal support leading to central mucosal contracture. Inflammation in the soft tissue envelope does not result in significant contracture if the septum remains intact. Even in patients with severe implant intracapsular pus drainage, severe contracture leading to the adhesion of the tip and rhinion is unlikely following explantation and irrigation, despite some contraction of the soft tissue envelope. This case describes secondary septorhinoplasty for a contracted nose in an Asian patient with multiple prior surgeries and infections. Using a septal L-strut extension graft, dorsal rib block, and soft tissue grafts, the surgery reconstructed nasal support and contour. The chapter includes detailed videos illustrating surgical techniques and long-term outcomes.