4 Nasal cosmesis following alveolar bone grafting in unilateral cleft patients K. Shekar, N. Jones, T.R. Flood. Salisbury NHS Foundation Trust, UK Objective: To assess the affects of secondary alveolar bone grafting to the unilateral cleft defect on nasal aesthetics. Methods: Secondary alveolar bone grafting was carried out with a formal reconstruction of the bony nasal floor. This retrospective study used pre and postoperative photographs to assess six components of nasal aesthetics. A panel of 12 used a five point scale to grade each component. Results: All assessors noted a statistically significant improvement in columella deviation (P = 0.008) and alar base symmetry (P = 0.001). The consultant surgeon group also noted an improvement in nasal symmetry (P = 0.014). Conclusion: Secondary alveolar bone grafting using a technique with formal reconstruction of the bony nasal floor using a cortical plate graft from the iliac crest appears to significantly improve the columella deviation and symmetry of the alar base.