The crooked or twisted nose results from a complex deformity of the bony pyramid, the upper and lower cartilaginous vaults, and the septum and causes functional and aesthetic problems. The forces of scar contracture coupled with long-standing cartilage deformation may make the crooked nose resistant to conventional surgical intervention. The middle vault of the nose may exhibit deformities that are due to atrophy, deviations, and skewing in relationship to the other regions of the nose. We report a series of 79 cases of significantly crooked noses to highlight 5 techniques not widely discussed in the facial plastic surgery literature.