<p>Button battery injury to the nasal cavity may cause severe late sequelae, including saddle nose deformity, septal loss, and structural collapse. Reconstruction in such cases is challenging because stable support must be restored in a scarred and distorted recipient bed. We report a 20-year-old man with severe saddle nose deformity after childhood button battery injury. Preoperative CT-based three-dimensional virtual surgical planning was used to assess the deformity and guide graft design. Autologous costal cartilage was harvested and carved into a dorsal onlay graft, columellar strut, septal extension grafts, and tip grafts for nasal framework reconstruction. Postoperatively, the patient showed clear improvement in dorsal height, nasal contour, tip projection, and nasal length, with maintained nasal airway patency and high satisfaction. No infection, graft displacement, clinically significant warping, or obvious resorption were observed during follow-up. This case suggests that the combination of three-dimensional virtual planning and autologous costal cartilage grafting may provide satisfactory functional and aesthetic restoration in selected patients with severe saddle nose deformity after button battery injury.</p><p><i>Level of Evidence V</i> 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>