Crooked Nose or Uneven Swelling After Rhinoplasty?

I had Rhinoplasty to "straighten" my nose. I just got my cast off and it is clearly not straight. If a nose looks crooked when the cast is removed one week after rhinoplasty, does that necessarily mean that the nose will be crooked when the swelling is gone? Or could it just mean that the swelling is uneven? I just pray that when the swelling finally goes away that it will reveal a straighter nose than what I am seeing now.

Doctor Answers 55

Nose crooked externally immediately after Septo-Rhinoplasty

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Hi Tiger,

It is too soon after your surgery and splint removal to make any judgments about the final shape of your nose. Give it another week, and hopefully as the swelling resolves, your nose will appear straighter.

It actually takes a few months for everything to settle, and revision is not recommended until at least 6 to 12 months if it remains crooked. An alternative is having filler such as Radiesse injected to even out any asymmetries.

Good luck, be well, and keep us updated on how it is going.

Dr. P

Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Nasal swelling can take a while

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Dear Tigerfan,

A crooked nose can be the result of crooked bones in the upper 1/3 of the nose(easy to fix), crooked cartilage in the middle 1/3 of your nose (moderate difficulty to fix) and distorted cartilage in the lower 1/3 of your nose (most difficult to fix). The bones can be fractured and realigned to appear straight and the risk of them returning to the crooked position is not high. The cartilage in the middle 1/3 of your nose include the septum and the upper lateral cartilage. These components require cutting, suturing and sometimes cartilage grafts to help straighten them.

I will often overcorrect to the oposite side of midline to insure a complete correction. Even in a perfect situation, sometimes the cartilage will return to the crooked position, but this generally happens slowly over time and is the result of cartilage memory and scarring. The nasal tip is made up of cartilage that will require suturing and grafts to make it straight.

Because it is the weakest cartilage in the nose, and because it is not attached to a solid structure as is the middle 1/3 of the nose, it is extremely difficult to overcome the forces of scarring to correct the tip. However, in my broad experience of revision rhinoplasty, rarely does the crooked nature return in the early post-operative period. Another reason for early crookedness can be assymetrical swelling or a small amount of blod under the skin. In any case, there is nothing to do at this point.

Relax, hope for the best!

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Patients are often suprised when the Rhinoplasty cast comes off

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I have a large number of patients that were not happy when they saw the results after the cast came off. Usually it may be because of swelling or they may not be used to seeing their new, different nose. Or possibly some cartilage grafts were used on one side of the nose in an attempt to straighten it, and the grafts are causing temporary swelling.

However, about 99% of the time after another week or two, they are extremely happy because the swelling comes down and the nice shape starts to come through. You should certainly discuss your concerns with your surgeon, but be patient for the final result to start showing. Good luck.

Dr. Miller

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 222 reviews

Rhinoplasty Recovery: Post-Operative Swelling

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In the first several weeks following a rhinoplasty, the swelling of the nose can be asymmetric. This can give the illusion that the nose is crooked or asymmetric. Post-operative swelling can also fluctuate from day to day on different parts of the nose for the first several weeks.

If your nose looks crooked after the cast removal, you should revisit your surgeon so that he or she can reassure you that what you are seeing is transient. There are often things that can be done in the office to optimize your result if in fact it is slightly crooked.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

Deviated Nose Correction and Swelling

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One of the hardest things to do in plastic surgery is correct a deviated or crooked nose. The problem, in many cases, is complex in nature and involves asymmetry of multiple cartilages, asymmetry of the underlying facial skeleton, and deviation of the nasal septum. While correcting all elements in a single surgery is not always possible, significant improvement can be achieved in the vast majority of cases.

Because correcting the deviated nose is, by definition, a more elaborate and aggressive type of operation, there is usually more pronounced swelling afterward than with standard rhinoplasty. This is especially true if the bones required straightening as well. When I perform foundation rhinoplasty, several grafts are used to compensate for these underlying asymmetries. Each graft produces a variable degree of swelling where it was placed.

Although you should be able to see some improvement early on, it is certainly possible that swelling is making your nose appear more crooked than it actually is. At this point, try to be patient and see where things settle. It is likely that you will see an improvement, provided that your chose a surgeon with experience in deviated nasal repair.

For more information about deviated nasal repair, check out the link below.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 55 reviews

Swelling is very common after rhinoplasty

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I would not be overly concerned at this point.

If it gives you any consolation, we generally do not take our nasal photographs for typically 6 months after surgery, due to the selling and distortion that occurs during this period.

In some instances surgeons may slightly overcorrect a deformity anticipating a slight recurrence.

In any event, I would discuss your concerns with your surgeon but give it time to allow the surgical results to settle.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Nose still crooked

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A number of things could be going on..
  • Yes, swelling could be making it looks still crooked
  • The bones may need to be helped along to heal straight.  We have our patients do gentle compressions for a week.  
  • The coating over the bone (called the periosteum) on the shorter side, the side to which the nose deviated, may be pulling the bones to that side.  Again gentle compressions, as shown by your doctor, may help.
  • Your nose will take about 18 months to heal.  Often deviations seen at one week go away over time. 

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon

Crooked Nose Surgery

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Before and After Photographs would be helpful to give you more specific advice.  That being said, swelling can make your nose look crooked.  Especially if you had osteotomies - where the nasal bones are broken.  Take serial photographs of your nose and you will probably see your nose getting "straighter" with time.   I also recommend "taping" to help control post-operative swelling.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 50 reviews

Crooked Nose After Rhinoplasty

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It is not uncommon for patients to feel unsure about their rhinoplasty results when the cast is initially removed due to swelling. The nose may appear to be drastically asymmetrical because swelling is not distributed evenly throughout the nose. However, the true shape starts to come through in about two weeks after surgery when the swelling starts to subside. At this time patients are usually extremely satisfied with their result. It is best to be patient during the recovery period and then address any concerns you have your with your surgeon.

Scott Chapin, MD, FACS
Philadelphia Plastic Surgeon
4.8 out of 5 stars 25 reviews

Crooked Nose or Uneven Swelling After Rhinoplasty?

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The circumstances that you described are reason for concern. There is a chance however, that surgical technique needed to straighten your nose required more intense manuvers on one side than the other and hence you may have uneven swelling. You will know better if the surgery was fully successful after 4 weeks and definetely after 6 months

Kris Conrad, MD
Toronto Facial Plastic Surgeon
4.0 out of 5 stars 11 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.