There is a myth propagated by many about a concept called “middle third” narrowing or “inverted-V” deformity in rhinoplasty. Essentially, the nose is skinny in the middle, but wide at the top and bottom. And like everything else in the rhinoplasty world, the only solution is to add something called “spreader grafts” to the middle of the nose to widen the nose, and apparently improve the airway. Also, like other grafts, all these do is camoflage the narrowing at best. In reality, the hourglass shaped nose is due to excess length of the septum and upper lateral cartilages, so the solution is to shorten these structures, and thus improve harmony in the nose, and improving the airway, via relaxation of the excess tension caused by overly long structures narrowing the skin and soft tissue of the external nose. I know this sounds confusing, but I am using one of my daughter’s fidget toys below to show how shortening the nose will remove tension and create better harmony from the front view. If you have this problem, its not quite as simple as moving the toy, but contact us to find out more if you need help with this problem for either primary (first) or revision rhinoplasty.