Crooked Nose or Uneven Swelling After Rhinoplasty?

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.

Swelling can often cause asymmetry of the nose shortly after surgery, particularly in the tip of the nose. So you need to wait a few months before judging the result. Remember that perfect symmetry is usually not possible. However, if you have noticeable asymmetry that persists, you may be a candidate for a touchup procedure. All rhinoplasty surgeons occasionally (15% of the time) reoperate to treat a persist deformity. Rhinoplasty surgery is difficult, even for the most experienced surgeons. I have attached a link to my website in case you wish to read more.

It is very common right after the cast comes off for the nose to appear irregular and crooked.  As the weeks continue and the swelling resolves the true structure of your nose will become more apparent.  In general I tell patients to try to not stare at their nose in the mirror for the first several weeks as you will find small irregularities that may go away and instead create a lot of anxiety.  As I am sure you know it takes at least 1 if not more than a year for the nose to settleGood luck

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

Hello and thank you for your question. Since you just had your splint removed, you are very swollen and it is difficult to evaluate the results at such an early stage. The final results take at least 1.5 years for the swelling to fully resolve. This can require lots of patience and waiting. Steroid injections performed by your surgeon can be extremely helpful. I usually start steroid injections around 1 to 2 months after surgery and continue as needed. Most patients are able to return to work and resume exercise one week after surgery. I recommend that you maintain close follow up with your 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

If the splint was recently removed, it is extremely likely that your nose is still swollen and the unevenness could be attributable to this. As a specialist in rhinoplasty surgery, I inform my patients before surgery about the swelling that can occur which temporarily distorts the look of the nose. Swelling decreases at its own rate, and it varies from person to person, so please be patient. If you have any concerns while you are healing, please follow up with your original surgeon. We surgeons should be extremely available to our patients for all questions, particularly during the healing process.

Thank you for your question and I appreciate your concern. Unfortunately, it is difficult to see what the nose is going to look like for many months after this surgery. It is possible the crookedness you see now is due to swelling as there can be significant swelling for many weeks and even months afterward. I assume you are going in for follow-ups with your surgeon, so I encourage you to bring up your concerns at your next appointment. However, understand that you will not see your complete result for up to 12 months or even a bit longer. At that time, if you are unhappy with your result, you could consider a revision procedure.

Your question is formulated very well since it can be either. Even if there is a genuine underlying problem, swelling can make it appear much worse. Because the support of the nose is elastic in the lower two thirds, swelling creates tensions that can end up distorting the shape. The cartilage of the nose is able to revert some of these temporary asymmetries as the swelling decreases and the soft tissue tensions come down. It usually takes 6-12 weeks for the tensions to decrease but sometimes spontaneous improvement is seen even later.

I would not be alarmed. The cast is usually removed one week after rhinoplasty. Most patients willl experience bruising and swelling that is noticeable to others for 1-2 weeks post-operatively, and it is not uncommon for the bruising or swelling to be uneven. The swelling will gradually subside over the following weeks, though you may notice that your own nose is swollen for another 2-3 months. It often takes one year for healing to be totally complete. 

Gary Linkov, MD
Rhinoplasty Specialist
Manhattan

It is not unusual to have some asymmetry when the cast is removed 1 week after rhinoplasty.  There is usually a lot of swelling and asymmetric swelling is quite common and can be the cause of what you are noticing.  I recommend regular follow up with your surgeon.  The final result from your rhinoplasty won't be visible until 6-12 months after surgery.  If there is still unsatisfactory asymmetry at that point, you should speak with your surgeon about a possible revision.  

Generally speaking, the nose should be straight when the cast is removed. Swelling can give the appearance of crookedness though and it’s very hard to diagnose without an in person examination. Express your concerns to your surgeon.Best