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To evaluate a surgical technique used to straighten and support the crooked middle third of the nose.Retrospective review of 41 patients with a markedly crooked nose who underwent correction using extended spreader grafts made from high-density porous polyethylene. Follow-up ranged from 6 months to 2 years.Every patient had substantial improvement in the straightening of the middle third of the crooked nose and the airway in one procedure. There were no cases of extrusion or infection.The extended spreader graft technique introduces structural reinforcement to permit straightening of the middle third of the nose. It is safe, effective, and reliable. The graft material provides increased strength against further trauma or the long-term forces of scar contracture. This technique has compelling benefits compared with all other techniques used to straighten the severely crooked middle third of the nose.