Dear Eiregrange, You would be a candidate for septorhinoplasty which is a combination procedure. The first portion of the procedure the "septo" portion addresses the deviated septum and the functional aspects to your nose. The "rhinoplasty" portion would address the aesthetic portion of your nose. Both aspects of your nose must be addressed to ensure proper function and aesthetics. I personally would use an open technique and yes you would require osteotomies. Once osteotomies and the septum are performed correctly there is little likelihood of the nose shifting back to its original crooked position. During consultation a computer imaging may be done which is able to show you some facial asymmetry which is present and then show you a proposed surgical result based on your entire facial anatomy. Best regards, Michael V. Elam, M.D.
Crooked nose repair can be performed with closed rhinoplasty techniques, which is very routine in our practice. The surgery will involve osteotomies of the nasal bones, a spreader graft placed underneath the concave upper lateral cartilage in the mid vault area and possibly a tip rhinoplasty. The dorsal hump could also be shaved down at the same time. Open rhinoplasty is not required. On a few rare occasions, the nose can drift back to the original position due to bone and cartilage memory.
Yes, it is definitely possible to straighten the nose. There is always a risk of the nose healing in a position that is still not in the middle of the face. The issue that needs to be discussed with you in front of a mirror is that, in addition to a crooked nose, you do also have asymmetry in your face. If you look at your upper lip you will notice that not only your nose, but your mid- and lower face are deviated to one side. This does not mean that a rhinoplasty will not improve your facial symmetry. However, your surgeon will need to have the experience to recognize this additional asymmetry and explain to you what can and can't be provided by rhinoplasty surgery. I hope this answer is helpful.
Stephen Weber MD, FACS
Denver Facial Plastic Surgery
Since your nose is deviated to the right from the outside is likely that is deviated to the left internally and it would be important to correct your deviated septum at the same time. Commonly this type of deviation causes breathing problems, sinus or sometimes migraine headaches which will improve with septoplasty. While your nose could be a difficult task for an inexperienced surgeon, it will not be a difficult case for someone who has experience dealing with the deviated noses. As long as certain principles are followed it would be very unlikely for the nose to shift again, at least not the same degree. Your nose will likely need osteotomies to realign the nasal bones, however, it would be difficult to be sure without touching the bones. Complex rhinoplasties may require longer surgery time but usually do not change the recovery substantially. Again I do not consider your rhinoplasty very difficult. Your tip is very wide but is not because you have thick skin since one can see the outline of your cartilages.
The problems you have can be corrected with a septohinoplasty. Deviation is one of the most difficult problems rhinoplasty surgeons treat. There is always a risk that the deviation is not completely eliminated but the best way to minimize that risk is to select an experienced rhinoplasty specialist. Your case is complex, you will need ostetomies, depending on your surgeon an open technique may be recommended, and your recovery will be a little longer than surgery on a less difficult nose.
Based from the photos, your nose is definitely crooked with low apex and mid dorsum, and an appearance of hump on profile.The tip is also bulbous and the alar is flaring.
For the nose, septorhinoplasty with osteotomy and alarplasty is the solution I can propose. Though the procedure will be relatively complex, the surgery can be done with closed rhinoplasty technique.
While achieving a perfectly straight nose is unlikely, improvement is certainly possible. This can be achieved with a closed rhinoplasty.
Kenneth Hughes, MD
Los Angeles, CA