Nose is crooked after 3-Piece Maxillary Lefort Osteotomy... can it be fixed? (photos)

During my 3-piece Maxillary LeFort Osteotomy surgery in May of last year my upper jaw was rotated 2 mm. As a result, my nose is now crooked. The Maxillofacial Surgeon set up an appointment with a Plastic Surgeon they have on staff and he feels there is little he can do. He said that if he straightens it, it will likely become crooked again. I'm not sure how experienced he is in rhinoplasty as there are no before/after images on their site. Is he correct, or should I get a second opinion?

Doctor Answers 7

Straightening a crooked nose

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The nose is made up of a pair of bones at the top. In the middle there are a pair of cartilages, and the tip is made up of a pair of cartilages. The septum runs down the middle separating the nose into the two different halves. Under the bone, the septum is made of bone, under the cartilage elements, it is made of cartilage. Your ear is made of cartilage, a soft springy material. The lower two thirds of the nose are generally the challenging area of rhinoplasty as the surgeon works with refining and straightening this flexible material, but leaving enough for support of the bridge and tip. 
The first doctor may not have had much experience with this type of problem. I would encourage you to seek a second opinion.

Nose is crooked after 3-Piece Maxillary Lefort Osteotomy... can it be fixed? (photos)

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It is certainly possible to get a crooked nose after a maxillary procedure. I presume that you had an advancement and this made your existing septal deviation evident, which was previously masked (I could be wrong as assumptions are often a dangerous thing-just trying to make some sense of it). If this is the case, you have a very deviated septum (would need to examine you in person to verify this) and this can be corrected by releasing/straightening the entire septum, buttressing the nasal support with grafts, and correcting adjacent structures (the upper lateral cartilage and columella) accordingly once the septum is straightened. I hope this helps. I wish you the best. 

Rhinoplasty and septoplasty to correct asymmetry after LeFort I osteotomies

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Thank you for your question and photo. Additional photos including frontal without smiling, side (profile) and from the bottom (base) would be helpful. This can certainly happen after maxillary advancement. Correction would consist of septoplasty, external approach rhinoplasty and cartilage grafting. The deformity occurs due to loss of support of the septum and tip, which are made of cartilage. Even with correction, over time cartilage can slightly warp (bend), though I believe with the right surgical plan you would likely be pleased with your long-term results.

I recommend you consult with a board certified facial plastic surgeon or plastic surgeon who is experienced in rhinoplasty.

Best of luck.

Nasal symmetry

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The right nostril can be brought up by removing a small portion of the vestibular skin on the right side.

The right supratip area has increased amount of cartilage which needs to be reduced and that will reduce the deviation.


Dr. J


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Because any type of a Lefort osteotomy involves cutting/manipulation of the septum, such a postoperative alteration can occur. It can definitely be improved but probably not by a 'simple' septoplasty procedure...which is probably to what the plastic surgeon was referring. It needs to be corrected from above and a more overall septorhinoplasty approach needs to be taken.


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NCSUEngr, I have two NCS Engineers, a daughter and a son; great school. Anyway, straight is a relative term when it comes to the face and nose in particular. Where our nose starts (the nasion) and where it ends or attaches inferiorly (the nasal spine or maxilary spine) frequently do not line up on a fall line. These two points do not change with a rhinoplasty. So what we do is try to fool the eye by getting the tip to line up better with the nasion giving  the illusion of being staight, among other things. It takes an experienced rhinoplasty specialist so look for someone that does "only faces" and has a lot of good photos. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

Second opinion

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I recommend you be evaluated by an experienced rhinoplasty surgeon who can be either a board certified plastic surgeon or facial plastic surgeon. Best of luck.

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