How is a Broken Nose That Twists to the Side Corrected?

 What exactly is involved in this kind of rhinoplasty?

Doctor Answers 10

How to fix a crooked nose

Correction of a crooked nose is one of the most frequent procedures that is performed by facial plastic surgeons. You may need to see a rhinoplasty specialist who is familiar with various techniques in traumatic nasal surgery. Many of patients with crooked nose have two underlying issues to address, one the external nasal shape, second the internal nasal obstruction. Although many patients are more concern about the shape of a crooked nose that can be easily fixed with cosmetic rhinoplasty, surgeon must also address the nasal obstruction simultaneously by performing a Septoplasty. Septoplasty is usually covered by insurance companies.

Orange County Facial Plastic Surgeon
4.9 out of 5 stars 204 reviews

With a fracture, you can have a great result

In general there are two types of crooked noses. One type was once straight but is now crooked because it was fractured. This type of nose can easily be improved with a resetting of the nasal bones along with shaving a bump down if present, and correction of the deviated septum. The other type of crooked nose is one that grows crooked without trauma. This type of nose is more difficult to fix and usually several steps are needed including cartilage grafting to create a final result that remains straight postoperatively. It is important to find a surgeon with a lot of experience in rhinoplasty and see pictures of crooked noses that he or she straightened. Good luck.

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 204 reviews

If crooked, nasal bones will need to be reset

The nasal bones, if crooked, need to be reset back to their normal straight anatomical position. Sometimes there is a dysjunction between the cartilage and the bone, and this is corrected with spreader grafts taken from the internal portion of the cartilage or the nose. All the incisions are placed inside the nose, and it usually takes a one-hour general anesthetic. This surgery is performed as an outpatient procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Unfortunately, the bones need to be refractured and set correctly

HI Raj,

When a nose is broken and left to heal in the wrong position, it has to be surgically rebroken (osteotomy), and then carefully reset and splinted. The inside of the nasal airway must also be inspected and any problems there corrected to avoid breathing restriction after surgery.

Go see a rhinoplasty specialist to get an evaluation. If you have health insurance, it may be possible to get your nose repaired if the fracture led to breathing restriction. It is never acceptable to get a nose looking better only to trade down to having breathing problems.

Good luck.

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 55 reviews

Nasal Fracture; How is a Twisted Nose Repaired?

Hi Raj,

When nasal bones heal crooked following a nasal fracture, it is necessary to re-fracture the bones, don't you go out and do it. No, see a rhinoplasty specialist who will perform osteotomies to realign the nasal bones.

Sometimes "onlay" grafts may be used to give an illusion of a straight nose without having to refracture the bones.

Good luck and be well.

Dr. P

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

The nose frame work needs to be aligned

The prior injury caused the bones and cartilage to be broken or pushed out of alignment. All of the supporting frame work of the nose will need to be addressed to get all of the parts put back into place. If the bone healed out of alignment it will need to be re-broken to put it back in place. The cartilage of the septum will need to be realigned to make the nose straight.

This is a challenging problem so choose you surgeon wisely.

Best Wishes

Dr. Peterson

Marcus L. Peterson, MD
Saint George Plastic Surgeon
4.6 out of 5 stars 38 reviews

Twisted nose

An accurate diagnosis will determine what needs to be done. A crooked nose can involve the nasal bones, upper lateral cartilage (the ones attached to the nasal bones) tip cartilages, (the ones that move) and/or the septum. An complete examination needs to be performed to see what is involved. On occasion only the nasal bones are deviated and so only osteotomies and re-setting the nose can be corrective. Most often however all the pieces are involved and so an open rhinoplasty approach is performed.

If this is the case usually the septum is harvested and used for grafting, the nasal bones are re-fractured and straightened, grafts along the side of the nose called spreader grafts are placed, the septum is reconstructed and the tip cartilages placed in a symmetric midline position. Correcting a severely deviated nose is the most challenging surgery to get just right. An expectation of significant improvement is appropriate, but perfection is not. That's not to say it can't be perfect, just don't expect it.

Edward Buckingham, MD
Austin Facial Plastic Surgeon
4.9 out of 5 stars 44 reviews

What is twisted is straightened.

The nasal bones and or the septum is usually twisted. The bones are refractured  and set straight. If the septum is twisted the cartilage has to be re-shaped and the deviated parts removed and then replaced after straightening the septum. You can also have the bridge and tip re-shaped at the same time. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

First pick a well experienced rhinoplastic surgeon

You need to be examined to see what needs to be done. Then the doctor will tell you. This is done with you asleep so there is no pain. The nose and sometimes the septum is straightened.

Very twisted noses can be quite challenging - but can usually be improved.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Make sure nose is fixed inside and out

In many ways, the very challenging correction of the twisted or broken nose can be viewed as the final step in the mastery of rhinoplasty. It challenges the great surgeon to restore the various deformities present using a detailed understanding of both cosmetic rhinoplasty and functional reconstruction. This is because septal deviation or septal fracture is very common with twisted and/or broken noses and its correction, in large measure, determines the long-term success in treatment of the associated crooked cosmetic deformities. That is why oftentimes, people who have broken their noses and had them treated in the emergency room, long term end up with a still crooked nose--the bones were straightened but because the septum was not, the nose twists over time.

Oftentimes, surgeons treating the crooked nose fall into one of two camps, those who attempt to simply "camouflage" existing deformities and those who attempt to restore and reconstruct the pre- injury state. Rarely, following acute trauma where minimal or no functional problems are present, we can use cartilage grafts to restore the pre-injury straight appearance. These thin slices of cartilage are placed over areas of depression or curvature to hide the contour irregularities. The irregularities themselves are left uncorrected. However, while camouflage techniques preserve maximal support, they may lead to a nose that is overly prominent and wide. That is why, in general, we also do not use or recommend injection rhinoplasty in these patients--it can make your nose too wide.

For most patients presenting with broken or crooked noses there is a vague history of previous trauma, often during childhood, which was not treated and eventually led to a twisted nose. Oftentimes in correcting the twisted tip or asymmetric nostrils, we have found that it is the deviated or fractured septum that is the main cause and not the broken bones. Reconstruction provides optimal aesthetics in these cases because it not only allows us to make the nose look straighter but also to restore the underlying framework to its normal pre-injury positions. This approach is balanced and allows us to address each cosmetic concern while maintaining and maximizing long-term support and function.

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