Background <p>Bulbous nasal tip surgery due to lateral-crural pseudo-malposition in medium-to-thick skin with weak cartilage is often challenging. Suture-only maneuvers may not reliably maintain the lateral-crural resting angle in such anatomy.</p> Methods <p>A modification of the lateral crural spanning graft was used in 17 consecutive primary rhinoplasty patients with bulbous tip deformity due to lateral-crural pseudo-malposition. A single-layer septal cartilage strip (lower lateral cartilage spanning spring graft, LCSSG) was integrated into a septal extension graft (SEG) through a slit, forming a cross-shaped construct. The LCSSG limbs rested on the cephalic borders of the lateral crura and were fixed with 5-0 PDS, creating a spring that reoriented the lateral crura and reinforced the alar rim. Demographics, skin thickness, fixation variant, follow-up, complications, and rhinoplasty outcome evaluation (ROE) scores were recorded.</p> Results <p>Seventeen primary cases (13 women, 4 men; mean age 32 years) with medium-to-thick skin (11 thick, 6 medium) were followed for a mean of 16.2 ± 5.4 months (range, 9–26). Mean ROE improved from 12.6 ± 3.1 (5–16) preoperatively to 19.4 ± 2.0 (13–22) postoperatively, with a mean ΔROE of 6.8 ± 3.4 (3–14). In the early suture-only group (n = 4), ΔROE was 6.8 ± 4.8 (3–13) and two patients (50%) developed mild supratip fullness with slight rim retraction. In the slit-anchored group (n = 13), ΔROE was 6.8 ± 3.1 (3–14) and no complications occurred.</p> Conclusions <p>The LCSSG–SEG construct provides a dynamic spring that reorients the lateral crus and supports the alar rim in primary cases with lateral-crural pseudo-malposition and medium-to-thick skin.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>."</p>