Objective: This is a review of modifications made to the classic technique for harvesting bone graff from the iliac crest. Prior techniques for harvesting iliac bone often resulted in significant postoperative pain, disability, and a cosmetically unacceptable scar and contour deformity. Design: A retrospective review of patients who underwent bone graff harvest over a 7-year period was done. Interventions: The modifications described use a skin incision medial to the anterior superior iliac crest. The medial aspect of the iliac crest is elevated along the midsagital axis of the crest. The medial cap is reflected outward, exposing cancellous bone. Results: A review of 51 patients demonstrated only two minor self-limiting complications. Conclusions: This procedure provides an abundant supply of both cortical and cancellous bone, an aesthetically acceptable scar, and decreased patient discomfort.