Crooked Nose After Asian Rhinoplasty

I am an Asian female that went through Rhinoplasty to make the bridge of her nose bigger. This is my second time undergoing this procedure, because the first time, the implant came out. It has been about a week and a half since my surgery, and my nose is really crooked. This didn't happen the first time I went through the procedure. I'm worried that it may not be the swelling, and that something might have gone wrong. What can be done to fix this?

Doctor Answers 7

Nasal implant should not look crooked

Secondary rhinoplasty is much more challenging that the initial procedure because of the scar tissue which can build in the nose. You mention that this is your second attempt at raising the bridge with an implant as the first implant eventually became exposed and had to be removed.

Nasal implants are a good solution in raising the nasal bridge but not a perfect solution. They require good coverage by the nasal skin. If the implant places too much pressure on the tissue or nasal skin it can be prone to "wear through" and become infected or exposed. The size, shape, and use of an implant requires careful judgment and the understanding of the potential for future disappointment.

Concerning your second operation, the new implant should not be crooked. It should be straight and true and blend well with the nasal bridge. Swelling should not influence the position of the implant.

Your nose should receive prompt attention from your plastic surgeon.

Best of luck,

Peter Johnson MD

Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Crooked nose after Rhinoplasty can sometimes be due to swelling

Asymmetry with Asian implant rhinoplasty is one of the most common complications with this type of surgery. I believe that it has to do with the approach and the fixation that is used to keep the implant in the middle and not asymmetric. Because it was your second time, there was likely a lot of scarring in your nose from the previous procedure. This can leave scar tissue that can serve as an impediment for a straight result.

Another reason for the asymmetry can be due to inherent asymmetry in the nose. An asymmetric nose will like remain asymmetric unless additional procedures are done to straighten the nose along with the implantation of your nasal implant. The crooked nose is one of the most difficult rhinoplasty cases out there. Although unconventional, I prefer to do all implants through an open approach. This allows me to clear scar tissue, open the nose and assure that the plane is correct, ensure that the implant is in the middle and lastly I can fix the implant in the middle with sutures.

Typically I fix the nose to the septum near the bone and septum junction and a point lower than that and then I secure the implant to the lower part of the nose and tip at a total of 4 different locations. This helps cut down on variables that can lead to asymmetry after rhinoplasty.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

Crooked nose after Asian Rhinoplasty

There are several methods of achieving correction of the nasal dorsum.

It sounds as if you underwent an intial implant which are typically fabricated from silicone elastomer or porous polyethylene.

However, it is not clear what the second procedure used:

Alloplastic materials

  • Silicone implant
  • Porous polyethylene

Autogenous materials

  • Septal cartilage
  • Conchal Cartilage
  • Costal cartilage
  • Iliac crest bone graft
  • Calvarial graft

Depending on what is used there may be several possibilities for what you are observing. Twisting or deformation of the softer materials may occur and may be minimized by placement of a straight wire or may need to be treated by replacement and suture fixation.

Alloplastic materials or grafts which have rotated may need to be rearranged.

The solution depends on the surgical techniques performed and that is not completely clear from your description. I would discuss these options with your surgeon first. It may be swelling as well which will resolve with time.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Is your nose significantly more crooked, or is it subtle?


Looks like you have been given a fair bit of good advice already, but I would simply add that you and your surgeon should be able to tell if there is problem or not, even at this early stage.

If the twist to the nose is subtle, it very well can be simply a matter of swelling because one side can settle a little faster than the other or look better on any given day early on.

On the other hand, if you are noticing that your nose is significantly more crooked than prior to the surgery, you should explore the problem a little further.

I hope this helps, feel free to let us know if we can be of further help.

Warm Regards.

Peyman Solieman, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Second surgery, twice the swelling

It is way too soon to judge your results, especially in view of the fact that you had a previous implant that was removed. Scar tissue and swelling can make early evaluation of your nose next to impossible. Be Patient!

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

Crooked Nose After Second Rhinoplasty in Asian Augmentation

Hi Mz,

Your surgeon is best suited to answer your question as he/she knows what was done during your surgery. You should address your concerns with your surgeon. If you are told that it is swelling, then there is nothing to be done at this point but to be patient and wait until the swelling dissipates. Give it another 10 days and let us know if it appears straighter.

A rhinoplasty surgeon should be able to distinguish between swelling and other causes of a crooked nose. I hope that things straighten out for you soon.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Nasal implant may have shifted

This is a tough problem. If a dorsal or L-strut implant was used it should have been centralized and should not be crooked now unless there is good deal of swelling. If you can palpate the implant off to the side then it is possible that it was dislodged and needs to be more accurately placed. I would go back to your surgeon, seek his opinion.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.