Treatment of saddle noses challenges the surgeon to provide esthetic form and functional improvement despite the presence of a limited amount of tissue to work with. The previous emphasis on alloplastic materials was a testament not only to the poor results obtained with autogenous tissues but also the unwarranted promise of the "miracles of modern chemistry." Only in the last 5 years have multiple surgeons begun to achieve outstanding results using autogenous tissues. It is hoped that this article will encourage younger surgeons to build on this foundation and provide hope to a group of patients who deserve our best efforts. Saddle nose and cleft lip nose deformity warrant a commitment to surgical excellence.