Nasal plastic surgery consists of both cosmetic and reconstructive techniques. Though the cosmetic procedures are widely discussed on these sites, very little is said about the reconstructive procedures. However, a truly good rhinoplasty surgeon is well versed in these techniques, as well. To understand the anatomy and external structure so that you can re-create what was lost from trauma or cancer surgery is the mark of a good rhinoplasty surgeon. The approach in reconstructive rhinoplasty involves creating a substructure, primarily of cartilage and occasionally bone, and a covering of skin and subcutaneous fat. The deeper structures are usually created with septal, ear or rib cartilage and occasionally cranial bone or hip bone. The covering is usually created from local, regional or distant flaps, skin grafts or composite grafts (skin & cartilage) from the ear. And though the exact underlying anatomy may not always be reproduced, the external appearance should very closely approximate a normal appearing nose.