Rhinoplasty to Correct a Crooked Nose

A “crooked” nose generally describes a nose that lacks continuous “brow-tip aesthetic lines.” These are lines that descend from the medial tips of the eyebrows in a vertical fashion along the sidewalls of the nose and end at the sides of the nasal tip. Ideally, these lines should form a modified hourglass configuration.

Perhaps the most common cause of severe crooked nose is trauma, as in a fall or a blow to the nose. A blow from the side will often push inward the nasal bone on that side, and push the opposite side outward. This creates a predictable disturbance to the brow tip aesthetic line.

When the nasal bones become crooked, they will generally cause a corresponding shift in the middle vault of the nose, which is comprised of cartilage, whereas the tip may stay in a midline position. This can lead to a “C – shape” deformity wherein the root of the nose and the tip are in the midline, but the middle two thirds of the nose are bowed outward.

In most cases, rhinoplasty to correct a crooked nose involves creating surgical cuts in the bony part of the nose to realign the nasal bones. The crooked middle part of the nose may follow the bones and realign itself without effort, but in some cases the surgeon must address each crooked part of the nose separately. The middle vault may require “splints,” much like a broken leg, to bring the sides back to the midline. These splints are called spreader grafts and can be created from the septal cartilage.

Sometimes a nose is not technically crooked but simply asymmetric. This means that one side of the nose is simply different than the other. A patient with an asymmetric tip for example may complain that their nose is crooked even thought the nasal bones are both straight. Generally, asymmetry does not require osteotomies or cuts in the bones to correct and is addressed with other rhinoplasty techniques involving soft tissue manipulation.