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The conchal cartilage butterfly graft has been shown to be an effective technique to correct dysfunctional middle vault due to overly collapsed bilateral upper lateral cartilage. In this case report, we describe two technical modifications of this technique to ensure secure middle vault nasal airway patency and to enhance surgical outcome. First, conchal cartilage is placed on the top of upper lateral cartilage in dorsal concave fashion rather than conventional dorsal convex pattern. Secondly, suture traction between the collapsed upper lateral cartilage and conchal graft was carried out to further resist collapse and provide prolonged durability. We believe that this technical modification offers a more refined method to correct collapsed bilateral upper lateral cartilage than the standard conventional technique. Therefore, we report in detail an improved operative technique that was performed on a 43 year-old male with chronic persistent nasal obstruction because of overly collapsed upper lateral cartilage. (J Clinical Otolaryngol 2010;21:257-260)