The authors use 5 basic suture techniques in tip plasty: transdomal, interdomal, lateral crural mattress, columella-septal, and intercrural, incorporating these techniques into a simple algorithm to control tip cartilage shape. They then introduce the universal horizontal mattress suture, designed to control all undesirable nasal cartilage convexities/concavities, and provide a new suturing technique that can be applied in all patients in whom a change of cartilage shape, including tip cartilages, is desired. They also apply these suture techniques in patients undergoing closed and secondary rhinoplasty.