Introduction: Nasal tip revision remains one of the most challenging procedures for plastic surgeons. Performing 3-dimensional anatomic nasal tip reconstruction by complete replacement of alar cartilages with ear cartilage allows optimal nasal tip correction in patients with severe alar distortion. We aim to describe this reconstructive surgical technique and report our experience with this procedure. Materials and Methods: We performed a retrospective analysis of patients who underwent complete replacement of alar cartilages as part of a revision rhinoplasty. Results: From January 2010 to December 2014, 569 patients underwent revisions, 20 (3.5%) of them with complete alar replacement. Additional grafts used were as follows: 8 columellar struts, 6 onlay grafts, and 3 spreader grafts. There were no in-hospital complications. At follow-up (mean 24 months), all patients reported satisfaction with the esthetic outcome and improvement in functional symptoms. No patient underwent further augmentation or repeat revision. Conclusions: Complete replacement of alar cartilages is an efficient surgical alternative for nasal tip reconstruction during revision rhinoplasty. This technique recreates the severely injured alar cartilage structure and returns the original nasal tip appearance.