Deviation the nasal

by / Thursday, 09 April 2015 / Published in Uncategorized

A Crooked Nose

A crooked nose attracts attention, and exaggerates otherwise normal asymmetries that most of us have. These cosmetic issues are often accompanied by breathing problems caused by the same structural damage.
A crooked nose bends to one side or the other, lacking a straight bridge. These noses can have either a curved or bumpy appearance, and can also be too big or too small.
A crooked nose can be caused by a deviated septum or an injury that has broken the bones. To straighten the nose, the bones need to be moved into a better position and are often reduced before being reshaped.

What makes it hard to straighten a deviated nose

One of the most difficult things to do during a rhinoplasty is to straighten a crooked nose. Several factors make this more challenging. The first factor is that the deviated cartilage and bone has a certain level of memory such that unless this is addressed the nose tends to drift back towards its pre-operative position. Another factor is that especially in congenitally crooked noses the nasal deviation may also occur in the setting of facial asymmetry. What this means is that it can be difficult to find a true midline plane in which to try to place the new nasal position.

What Is Involved In Straightening A Crooked Nose?

To create a more straight nose the underlying framework must be made as straight as possible. This includes repositioning the septum and nasal bones. If a septal deviation is not addressed it may continue to push the nose off center. If the caudal septum is off center this portion of the septum can be rebuilt in the midline. Once the septum is centered any deviation of the nasal bones needs to be addressed.


Deviation the nasal

What Else Leads To A Deviated Nose?

Additional factors that can lead to the appearance of a crooked nose include internal and external valve collapse. The shadowing that results from this narrowing is what creates this appearance, especially when it occurs asymmetrically.

Before and After Rhinoplasty Crooked Nose Rhinoplasty

The patient shown below is a great example of this concept of correcting a severely crooked nose.



The patient’s severe nasal deviation to his right is obvious. This outward appearance is also reflected in his chronic nasal congestion and chronic mouth breathing. If we try to drop down a line showing the patient’s midline one can see how the patient’s tip is about a centimeter off midline. Did you notice that the patient’s midline upper lip doesn’t line up with the middline of his forehead teeth or chin? In cases like this I often find it best to place the new nasal position in line with the axis of the overall facial structure. Otherwise, a seemingly straight nose on an asymmetric face can look quite out of place.


Asymmetrical nose

How to straighten deviated nasal bones

Using an open septo-rhinoplasty approach I was able to reconstruct the patient’s septum, relocating its starting point by the nostrils about a centimeter toward the left. To prevent the remainder of the nose from trying to veer back toward the patient’s right I needed to detach much of the cartilagenous support from the surrounding bone and septum and then re-connect these components in their new, midline position. I also placed bilateral spreader grafts to help open up, straighten and support the narrow middle third of his nose.

The deviated nasal bones are made more straight by creating precisely controlled bone fractures under the skin using an osteotome (a fine-tipped, medical grade chisel). Once the bones are mobile they can be repositioned into a straighter position. After about 6 weeks the nasal bones are fully reset in their new position. Below you can see the before and 1 year postoperative results of this patient.


You can see that the patient’s nose is much straighter in the 1 year postoperative photo. The patient’s chronic nasal congestion was also greatly improved thanks to the more open nasal airway.


Preoperative and postoperative



Preoperative and postoperative




Preoperative and postoperative

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