This is another area I have given considerable thought to. It was a pleasure to lecture on the subject in a Masters “State of the Art” seminar with Wolfgang Gubisch. We had not shown each other our key messages before so it was very gratifying for me to hear him talk with the same philosophy. We both felt that a step-wise approach to reducing each component of the nasal bridge individually was best and that autospreader flaps are a big step forward in reshaping the middle third of the nose after bump removal. We both favour the open approach. I also spoke at a Masters seminar on the twisted nose. I think the deformed septum is a challenging problem. My preference again is the open approach which gives the best opportunity for accurate diagnosis of the deformity. Jay Calvert again moderated. We agree on trying to perform total septal reconstruction keeping the septum inside the nose rather than using the the extra-corporeal septoplasty technique when the septum is removed completely from the nose, then reshaped and returned. I think this is especially important in the nose that also requires bridge hump reduction.