The most challenging aspect of septal L-strut reconstruction is addressing defects in the high septum. The primary causes of mucoperichondrium loss in the high septum include iatrogenic defects due to alloplastic implant problems, severe contracture, and associated saddle deformities corrected during surgery or accidental damage incurred during the septal surgery. When L-strut reconstruction is imperative, two approaches are available: creating a local flap to cover the insufficient mucoperichondrium or allowing for natural healing using biological covering. This case describes secondary septorhinoplasty for high septal defect repair in a patient with prior infection, saddle deformity, and multiple septal perforations. Using a septal L-strut extension graft, laminated rib, perichondrium, and fascia, the nasal framework was rebuilt. Detailed surgical videos document the reconstruction and long-term outcomes.