Correction of major saddle nose deformities is one of the greatest challenges in nasal surgery. Here, a new approach for the correction of major saddle nose deformities in which the missing parts of the nasal skeleton are replaced with their anatomic replicas sculptured from an autogenous osteocartilagineous rib graft is presented. Since 1998, this new technique has been used in 17 patients (11 females and 6 males) with major saddle nose deformities. The age range was between 19 and 37 years. The etiology of saddle nose deformity was iatrogenic in 11 and traumatic in 2 patients. In the remaining 4 patients, saddle nose was a part of ethnic facial features. During a mean follow-up of 2 years, the sculptured nasal frame maintained its form and resistance. There was no patient with recurrent nasal collapse or airway obstruction. The nasal tip was naturally mobile in all patients. Replacing the missing parts of the nasal skeleton with their anatomic replicas created from autogenous tissues, this new technique restores all anatomic and functional features of the nose. It efficiently corrects saddle nose deformity and eliminates associated functional deficiencies.