The Middle Eastern nose has an number of specific nasal features that variabily exist. The purpose of this study was to observe the degree of improvement of the aesthetics and functional as well as complications rate of the middle eastern primary rhinoplasty with the placement of alar contour grafts in the primary open setting. 12 male patients and 23 females with the criteria of the middle eastern nose all performed primary open rhinoplasty with insertion of alar coutour grafts. Subjective evalution of patients was done as well as questionnaires. Digital photographs were documented and all were followed up for up to 2 years postoperatively. There was marked improvement noticed both aesthetically and functionally. It should be noted that there has been an increase in the number of patients seeking rhinoplasties in the middle-east over the past decade, with an observed increase in male frequency. Most of these patients only have their face visible in their daily interactions due to religious and cultural factors. Alar rim contour grafts have demonstrated a clear impact on the aesthetic and functional (external valve function) outcome in the primary open rhinoplasty in the middle-eastern nose. They have become a corner stone for the improvement of alar shape achieved in the procedure and have been shown to circumvent complication and avoid the clear long term worsening of the aesthetic parameters when not used. Key words: Rhinoplasty, Alar grafts, coutour grafts, Alar rim grafts, tip countouring, primary rhinoplasty, secondary rhinoplasty.