ABSTRACT: Congenital aplasia of the cartilaginous nasal septum is an extremely rare condition. We present the case of a 22-year-old Filipina who sought aesthetic correction of a flattened nose. Physical examination revealed a short nose with a low dorsum, lack of tip projection, right alar notching, perialar flattening, a shortened columella, and an acute nasolabial angle. Cranial radiography showed no congenital craniomaxillofacial anomaly. The patient underwent open structural rhinoplasty with a septal extension graft (SEG) using polycaprolactone (PCL) mesh and dorsal augmentation using expanded polytetrafluoroethylene (ePTFE). Intraoperatively, complete absence of the cartilaginous nasal septum was confirmed. Postoperatively, the patient demonstrated satisfactory aesthetic and functional outcomes, with improved patient-reported quality-of-life scores. This case highlights the surgical management of congenital cartilaginous nasal septal aplasia using structural rhinoplasty with a PCL mesh SEG and reports the resulting aesthetic and patient-reported outcomes.