Is Correcting a Crooked Nose a Difficult Procedure?

Straightening a crooked nose, especially a revision, may be one of the most difficult of all plastic surgery procedures. In the bony portion, upper ⅓, the bones can be broken and moved and usually will stay where you place them. The problem is the cartilage which makes up the lower ⅔ of the nasal dorsum, the tip, and septum. Cartilage, like rubber, has memory, you can slice it, dice it, score it, to bend it straight and it may bend back. Hopefully it will bend just a small amount and not near as bad as the original deformity. This makes just taking a hump off very simple.
Even a very experienced rhinoplasty surgeon may not get it perfectly straight. It is frustrating when a nose that is straight when you finish, can bend back years later. But usually it's minor and doesn't require a revision.
The severe cases like hockey players, rodeo cowboys, or anyone whose nose has been broken multiple time and sits sideways on the face, I promise only a 50 to 75% improvement. The goal is to establish an airway and get it close to straight. The super model with a slight deviation will be more difficult since she's expecting perfection. After 34 years, I find that managing patient expectations can be as difficult as the surgery itself.

Hello and thank you for your question. Straightening the crooked nose is one of the most challenging things to do in all of Rhinoplasty. I would highly recommend that you evaluate your surgeon’s results in their before and after gallery and you should be able to see numerous pictures of straightening a crooked being performed on real patients. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Correction of a crooked  nose is one of the most challenging tasks in rhinoplasty. These deformities can be related to nasal bones, cartilages or both. In either case, a unique set of challenges are involved and it is important to discuss realistic expectations, as perfect symmetry in human body is more of an ideal rather than a reality. The agreed goal in general should be to achieve a solid improvement of asymmetry rather than attaining perfect symmetry. 

Rhinoplasty is frequently quoted as being the most difficult procedure in cosmetic surgery. One challenge that patients and surgeons face is the task of straightening a crooked nose.  Usually it is possible to make significant improvement in symmetry and straightness (both inside and out) -- but, making a nose perfectly straight is very difficult.  As surgeons, we do have a certain degree of control in the operating room and the goal is always to make the nose look the absolute best (straightest!) as possible. However, what we dont have control over is the healing process. It is possible for a nose that was made near perfectly straight in the operating room, to become slightly crooked before it heals completely. If the nasal bones are surgically broken, they can shift slightly due to swelling or from an accidental bumping of the nose, which can cause it to shift slightly.

A deviated nose is one of the most challenging endeavors for rhinoplasty surgeons.  Patients should have the expectation that the nose will look improved but not perfectly straight.  Since every deviated nose is unique, the procedures required to fix it will vary from patient to patient.  Here are some reasons for persistently deviated noses after surgery:
1.  Swelling-  It can take up to a year or more for swelling to resolve.  Swelling can have an impact on how the nose looks.  Early on it may be difficult to see how the nose looks until swelling resolves.
2.  Incomplete correction-  Under correction is one of the most common results after repairing a deviated nose.  If the result is from persistent deviation of the bone of the nose, a minor correction can be used to help align the nose.  If the resultant deviation is due to cartilage in the nose, a more major procedure may be indicated.  In extremely deviated noses, patients may require an additional minor procedure to help the nose look straighter.
3.  Cartilaginous and soft tissue memory of the nose-  The cartilage of the nose has memory and depending on the technique utilized may influence the nose back to the deviated side.  Even in radical reconstructions of the nose, the soft tissue memory of the nose may influence it slightly back to the original deviated side.  

Crooked nose repair is one of the most difficult maneuvers we perform during rhinoplasty.

Part of the difficulty in straightening a crooked nose is that the cartilage and bone of the nose have memory. This creates a situation where the bone/cartilage that is out of place wants to revert back to its original position.

There are several techniques that we can use to address this. Regardless, perfect symmetry is always difficult to achieve with any surgery.

Generally speaking, straightening a crooked nose is a very challenging procedure and it is essential to have a specialist perform your surgery. It is important to have realistic expectations, as it is difficult to obtain a perfect result where the nose is 100% straight. Thank you and I hope this helps.

yes - correcting the crooked nose as a part of rhinoplasty is difficult.  choose a well trained and experienced plastic surgeon.  one of the keys to correcting the crooked nose is attention to the the septoplasty.  often i approach the severly crooked nose (due to prior trauma or prior failed surgery) with an open spetoplasty approach.  This allows full visualization and modification (with sutures, scorring, and grafting) of the remaining L-strut. 

Correction of a crooked nose takes two forms: 1) correction of a previously straight nose which has been traumatically altered, 2) a congenitally "off center" nose.  Although both circumstances present challenges for the most experienced Rhinoplasty Surgeons, it is the latter that present the most difficulty.  A congenitally crooked nose often presents with the nasal spine (and the hence the line between the upper incisors) off center from the nasal bones.  This situation can be be camouflaged, but is very hard to correct.  Likewise, deflection of the dorsal septum usually follows this "off center" line and repositioning does not always lead to a perfectly straight line.

A crooked nose is challenging, depending on the cause of its crookedness. It is certainly more technically challenging to fix than a dorsal hump. Crooked noses usually involve cartilage that is twisted or curved. Unlike bone which breaks when bent, and can easily be filed down, cartilage has memory and reverts back to its original form unless properly reshaped and sculpted. There are several different methods and tricks for correcting a crooked nose (they are too technical for me to describe here), so if you are thinking of having yours fixed, please consult with a board-certified plastic surgeon who specializes in rhinoplasty surgery. Please ask detailed questions to ensure that your surgeon is experienced in handling complicated cases.