Background <p>Saddle nose deformity results in functional nasal obstruction and significant aesthetic compromise. In advanced cases, rib cartilage remains the most reliable autologous source for reconstruction. However, achieving long-lasting symmetry and contour remains challenging. To evaluate the functional and aesthetic outcomes of a novel three-component autologous rib cartilage reconstruction technique incorporating a columellar strut, bilateral spreader grafts, and diced cartilage with perichondrial overlay.</p> Methods <p>This retrospective cohort study included 37 patients (24 female, 13 male) with moderate to severe saddle nose deformity who underwent single-rib, triple-layer reconstruction. Preoperative and postoperative evaluations included the Visual Analog Scale (VAS) for nasal appearance, Nasal Obstruction Symptom Evaluation (NOSE) scale, and a 5-point Likert scale for patient satisfaction. Advanced statistical analyses were conducted to assess effect sizes and responder rates.</p> Results <p>VAS and NOSE scores improved significantly (p &lt; 0.0001), with large effect sizes (Cohen’s d &gt; 4.6). Mean operative time was 187 ± 21 min. Patient satisfaction was high (mean 4.16 ± 0.73), and over 86% reported being satisfied or very satisfied.</p> Conclusions <p>This technique provides stable structural support within the studied cohort and represents a feasible reconstructive option for selected patients with complex saddle nose deformities.</p> <p>Level of Evidence: Level IV, risk / prognostic study.</p>