Correction of the severe cleft lip nasal deformity is challenging and we used the composite graft to correct the cleft lip nasal deformity with severe tissue deficiency or severe nostril asymmetry. A total of 19 patients, who were born with complete cleft type, was operated between 1995 and 1999. Among them, 10 patients were men and nine were women. Age distribution was seven to 35 years old. In nine patients with unilateral cleft lip nasal deformity and six patients with bilateral cleft lip nasal deformity, columella lengthening was performed using composite graft taken from the helix in 14 cases and contralateral alar rim in one case. In four patients with severe asymmetric nostrils due to a short alar rim in unilateral cleft lip nasal deformity, the ear helix was used in two cases. while in the other two cases the alar rim of the unaffected side was transferred to the affected side to make symmetric nostril by reducing the length of the alar on the affected side. Follow up periods ranged from one to three years, and results were as follows: 1. Four days after the graft, the composite tissue exhibited a pinkish color. Complete survival was confirmed after seven days. The absorption rate observed was about 10 percent and color mismatch became minimal with time. 2. Composite tissue taken from the ear was found to be useful for a full layer reconstruction of the alar and columella due to its stiffness, thin nature, and similarity. Composite tissue from the alar rim of the contralateral side was also determined as good material for a full layer reconstruction of the deficient alar.