How much can my nose be fixed? 6 years after being punched.

Question

Hello, I had an incident about 6 years ago a random guy in the street throw me a punch on the left side of my nose and it got crooked. Unfortunately, they werent able to see my nose crooked at the emergency and the ENT called me a little too late for manual reduction. I have my left side that is concave up to the eye level, a deviated septum (not severe), and a nasal valve collapse in the middle right side of my nose. My question is: how much of improvement can a rhinoplasty bring me? I am not looking for the perfect nose but only a straighter look from the front view, and fix my deviated septum allong with the nasal valve as it difficult for me to breathe from my right side. Also, can a closed rhinoplasty be possible in my case? I have attached 3 photos of me now, and 1 photo of my nose before the incident.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can see from your photos you are a very suitable candidate for rhinoplasty operation, but open rhinoplasty is always a better method because it is possible for the surgeon to see and intervene in every area.
It would be better face to face consultation.
Best Regards!

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have widening of your nasal bone on the right side, along with a right nasal sidewall indentation. You also have an overprojected nasal profile appearance of your bridge. That means that your bridge sticks out a bit too far and is associated with a dorsal hump. Please consider meeting with several reputable rhinoplasty specialists so you could see what to expect after surgery to achieve a straighter, and less distracting nasal appearance. I hope this helps! Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a rhinoplasty to help straighten your crooked nose. Maneuvers for your surgery would include osteotomies, dorsal hump reduction, placement of extended spreader grafts, among other maneuvers to help straighten your nose. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

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

Best wishes and good luck.

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

Zoran Potparic, MD · Answer

Based on these photos and functional, breathing problems you have a structural septorhinoplasty will be most appropriate solution for your problem, This will include correction of the septum, nasal airway, reposition broken/displaced bones and create aesthetic improvement of the external nose. In person consultation with a board certified plastic with expertise in rhinoplasty is recommended. Good luck.

Ronald J. Edelson, MD · Answer

Your nose could be improved with a rhinoplasty. Not all surgeons do closed rhinoplasty but yours could be done that way. But I wouldn’t base my selection of surgeon solely on closed vs open

Gary M. Horndeski, MD · Answer

You would benefit from an open rhinoplasty/septoplasty with possible cartilage graft.  The cost is $8,000 and the procedure takes 2 hours to perform under general anesthesia.

Best Wishes,

Gary Horndeski, M.D.

William Portuese, MD · Answer

A closed rhinoplasty approach can accomplish shaving down the dorsal hump, straightening the nasal bones, and adjusting the concave upper lateral cartilage is in the mid portion of the nose with spreader grafts, in addition to shaving down the dorsal hump, which is crooked itself. Also important to evaluate the internal portion of the nose to see if you have a deviated nasal septum, which frequently occurs when you have a nasal fracture. Significant improvement can be accomplished with a closed rhinoplasty approach with all of the incisions placed on the inside of the nose. No external incisions are required, no painful packing is required either.

Mats Hagstrom, MD (license on probation) · Answer

The time to fix facial fractures is within a couple of days of the injury when the bones want to sit in their original position.
Once scar tissue starts building up the bone fragments start locking into the deviated position.
Now, if you break the bones they’ll wanna go back to where they were after healing from your fracture.
 Basically, the idea is to fracture the bones with enough fracture to put the nasal bones in reasonably good alignment.
Sometimes this works better than other times because the surgeon may have a challenging time, knowing exactly where the fracture line was from your injury.
It can definitely be done with a close rhinoplasty, though a tiny cut Inside your nose, maybe necessary to insert the Osteo to used to break the bone.
I think getting some improvement in your case will be pretty straightforward.
It’s really unfortunate. They didn’t get you in on time to reduce this manually.
Manual reduction is really simple.
You can literally push in a popsicle stick and push the bones in place.
 I’m not recommending people do it themselves, but I do recommend that they kick and scream until they get in to see ENT or plastics ASAP after these injuries.
The idea that it’s better to let swelling go down for a couple of days before reducing fractures is hogwash in my opinion.
Whenever I hear these stories they remind me of lazy providers who didn’t want to do the right thing because it was inconvenience. 
Consult with ENT or plastic surgeons, especially those who do a lot of nasal surgery and especially those who take facial trauma call.