Background: The literature reporting outcomes in crooked nose patients submitted to surface dorsal preservation techniques is almost nonexistent. Objectives: To evaluate aesthetic and functional outcomes in crooked nose patients undergoing rhinoplasty with the Spare Roof Technique (SRT). Methods: Prospective, interventional, and longitudinal study performed on patients presenting a crooked nose undergoing primary rhinoplasty by SRT. The validated Portuguese version of the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty and a visual analog scale were used to assess aesthetic and functional outcomes, respectively. Patients completed the questionnaire preoperatively and again 3 and 12 months postoperatively. Results: The study population included 54 Caucasian Mediterranean patients (34 female), mean aged 34.5 years. The SRT resulted in a highly significant improvement in all questions regarding subjective body image in relation to nasal appearance and subjective nasal function. The mean preoperative aesthetic Utrecht Questionnaire sum score was 13.4 (standard deviation [SD] 0.5), which improved to 9.2 (SD 0.15) at 12 months postsurgery (p < 0.001). Conclusions: The SRTa is a reliable technique that can help deliver consistently good results in reduction rhinoplasty in patients with a crooked nose.