The removal of a dorsal nasal hump is a commonly performed procedure in rhinoplasty. It is crucial and essential to reconstruct the middle vault in order to stabilize the function of the nasal valve and achieve the desired aesthetic lines of the dorsal area. The nasal midvault consists of the upper lateral cartilages and their attachment to the nasal septum and bones. The keystone area, which is the junction of the quadrangular cartilage to the nasal bones and the attachment of the upper lateral cartilages (ULCs), is a critical structure in the middle vault. Failure to restore the middle vault after hump removal can lead to functional complications such as internal nasal valve collapse, saddle deformity, and inverted-V deformity, as well as aesthetic issues. Patients with a tension nose (high nasal dorsum combined with a long caudal edge and stretching of the skin and soft tissue), dorsal hump (short nasal bones and long ULCs), and midvault asymmetry and deviation are suitable candidates for middle vault restoration. Spreader grafts, which are two strips of cartilage placed between the dorsal septum and ULCs, are currently considered the gold standard for middle vault restoration. Another technique, known as spreader flaps, involves inward folding of the ULCs and can also be effective in reconstructing the nasal middle vault.