How crooked nose correction works

Why is a crooked nose difficult to correct?

A crooked nose is one whose midline leans to one side when seen from the front. One review explained that correcting a crooked nose is one of the most common requests from rhinoplasty patients, and that problems with appearance and function are usually present together ^[1].

The same review said correction is especially difficult because many structures, both outside and inside the nose, are often involved ^[1]. A crooked nose is described as developing when external forces and forces within the nose twist its structure, and a severely crooked nose is almost always accompanied by a major septal deformity ^[1].

The first step is finding which part is crooked

A 2022 review explained that before correction, any underlying asymmetry of the face itself should be carefully assessed, and it should be determined whether the crookedness comes from the upper third, middle third, or lower third of the nose ^[2]. Surgery is described as being planned accordingly, using the appropriate technique for each crooked section ^[2].

Roughly speaking, the upper part corresponds to the nasal bones, the middle part to the upper lateral cartilages and the septum, and the lower part to the tip cartilages and the end of the septum. If the face itself is asymmetric, the face as a whole may not look symmetric even after the nose is straightened, so it helps to understand this in advance.

Types of correction methods

When the nasal bones are crooked, an osteotomy is performed to cut the nasal bones and reposition them. Osteotomy involves many techniques and instruments, with no widely standardized classification, and for predictable results, cutting around the nasal bones with medial, lateral, and transverse osteotomies is emphasized ^[3].

In the middle part of the bridge, the spreader graft is used as the main method of rebuilding the middle vault, and it is described as restoring the aesthetic lines of the bridge and supporting the straightened nose ^[4].

When the septum is severely crooked, extracorporeal septoplasty is sometimes used, in which the septum is taken out, straightened outside the body, and put back, and a review of rhinoplasty in Asian patients presented the author's modified version of this method for correcting a crooked nose and a convex bridge ^[5]. The open approach is described as especially useful for correcting a crooked nose ^[1]. More recently, a modified dorsal preservation technique has also been presented as a new way to address crookedness ^[2].

Breathing is assessed as well

A crooked nose often comes with functional problems as well as cosmetic ones ^[1]. The middle part of the bridge is closely linked to the internal nasal valve, so spreader grafts are also described as being used to restore or maintain this valve ^[4].

One review considered prevention to be the ideal treatment for problems in the middle part of the bridge. The risk factors it listed that can be identified during the preoperative consultation were short nasal bones, long and weak upper lateral cartilages, thin skin, previous injury or surgery, a positive Cottle maneuver (a test in which the cheek is gently pulled to the side to see whether breathing improves), a tension nose deformity, and an inferior turbinate that sits toward the front of the nose ^[4].

When these risk factors are present, it is summarized that preventive measures should be considered, such as preserving the support structures of the middle vault, removing a dorsal hump cautiously, performing conservative osteotomies, and reconstructing with structural grafts ^[4].

The chances of recurrence and revision surgery

Even after surgery, some crookedness can remain or come back. A review of revision surgery in Asian patients cited crookedness that persists or returns as a problem that frequently requires revision surgery ^[6]. Functional and cosmetic problems related to the middle part of the bridge are also summarized as one of the common reasons people seek revision surgery ^[4].

Complications cannot be completely avoided in rhinoplasty, but understanding their causes and taking preventive measures is described as greatly helping to reduce how often they occur ^[4]. A review of rhinoplasty in Asian patients explained that, because bridge implants and grafting procedures are widely used, the rate of revision surgery to correct complications is relatively high ^[5]. There is also a view that results should be measured with patient-reported outcome measures ^[2].

What to check during your consultation

The cause and location of the crookedness differ from person to person, so the same method does not suit everyone. It is best to confirm the condition of your nose through an examination and any necessary tests, and to discuss in advance the range of results you can expect.

• Whether the crooked part is the nasal bones, the cartilage, or the septum
• How asymmetric your face itself is
• Whether you have functional symptoms, such as a stuffy nose
• Any history of previous injury or surgery
• The chance that some crookedness remains or comes back