In the early twentieth century, Dr. Freer and Dr. Killian pioneered the submucosal resection (SMR) technique to alleviate nasal obstruction by excising the protruding sections of the nasal septum. However, in Asian countries, this procedure is often performed not only for nasal obstruction but also to harvest cartilage for grafting purposes, regardless of the presence of obstruction. Asian septal surgery uses submucosal resection (SMR) and the swinging door procedure to harvest cartilage and align the caudal septum. Careful assessment is needed to balance graft yield against preserving L-strut integrity. Small noses often offer limited septal cartilage, making harvest unrealistic. Maintaining membranous septum integrity and reinforcing the caudal septum are key for successful septal extension grafting. In secondary rhinoplasty, prior implants may reveal masked saddle nose deformity.