Treatment of bulbous nasal tip is difficult. In the presence of thick, inelastic skin, cartilaginous framework should be supported in special areas. Many tip grafting techniques have been described but the results usually are not satisfactory. We developed a new tip grafting technique to provide extra support and extra length to the nasal tip. The graft is prepared from the septal cartilage and has an extended "A" appearance. The tip graft is supported with a columellar strut graft. Both grafts are inserted into small separate pockets through separate incisions. If necessary, the alar base is reduced with a modified Weir technique. Fifty-two patients were treated with this technique over the last 3 years. Results were satisfactory in all patients without any complications such as graft displacement, infection, or resorption. Extrasupported tip graft is an effective method in the treatment of bulbous nasal tip with thick skin.