The thick heavy skin represent a challenge for any surgeon who is performing rhinoplasty. When combined with underprojected tip would be a real problem. The accompanying weak lower alar cartilage could add a real support deficiency. This ethnic problem had led us to think about a solution that could provide a solution for both the tip projection and the heavy skin. Although the extended columellar strut–tip graft proved to be a reliable method to provide nasal tip projection and contour, yet it lacks the adequate tip support for the heavy nasal skin. The combined extended columellar strut-tip graft is the solution in order to maintain the alar cartilage support and providing a good dome definition at the same time. Our study was done on 60 patients, 38 of which were secondary cases, while the remaining were primary cases. The follow-up of cases extends to 24 months. Patient satisfaction was subjected to a patient satisfaction poll over 5 grades. Only 5 cases were not satisfied by the result. We had reached a conclusion, that the combined strut–tip graft is highly versatile in that it offers unique advantages in both primary and secondary rhinoplasty procedures. Keywords: Tip rhinoplasty, columellar strut, tip graft, thick skin rhinoplasty, extended columellar strut graft.