Type of Rhinoplasty for my Crooked Nose?

I am 25-year-old female with a nose I do not like. What type of Rhinoplasty would you perform on my nose? Looking at my nose from a front view, my nose is crooked. At times I have trouble breathing from both nostrils when sleeping on a side. Hump looks different from right or left profile view. I’ve read about open and closed procedures and wonder what you would do? What price range would I be looking at?

Doctor Answers 11

Deviated Nose Correction Options

There are 2 issues at play here: Function and Appearance.

First, your functional issue sounds like a combination of septal deviation and inferior turbinate hypertrophy/enlargement. Your septum likely deviates to the left up top and to the right lower down. Turbinates have erectile tissue in them that swells easily. Allergy, hormonal cycles, environmental irritants can create swelling. Lying flat also causes them to swell. This is sometimes called 'recumbancy rhinitis.'

When you sleep at night, you have an increase in the amount of blood that is in the head compared to when you are upright during the day (blood settles in your legs and feet). The side of the nose that is down on the pillow also tends to get more stuffed, as gravity pulls some of that extra volume into that nostril. If I had to guess, I would suspect you have the most obtructive symptoms when you lie on your left side.

Sometimes, your eyelids show the same phenomenon after sleeping, where one side is a little puffier than the other.

The outside of the nose is reflecting a septal deviation. Based on the photo, it seems like a developmental one. The nasal bones, septum and tip are all tilting to the left side in a straight line, what I call a linear deviation. These deviations tend to be developmental more than traumatic in origin.

There seems to be a bump, which, due to the deviation, will look different from each profile angle. The tip cartilages appear a little wide and the tip is a little down, creating extra length to your nose. You may also have an overactive muscle that pulls your tip down farther when you smile in photos. That being said, an examination would be required to verify any particular surgical plan.

I personally would fix your nose closed, as that is my preference most of the time anyway. What is done is more important than the approach that is used.

Cost varies depending on whether you have a medical problem (septum/turbinates) and whether your insurance would cover those portions of the case. Cosmetic fees can range from $1000-$10,000 depending on many factors.

Good luck. Please feel free to send additional photos if you think it would help.

Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 51 reviews

Rhinoplasty procedures and approach

I reviewed your picture. The issues you described can be handled using either the "open" or "closed" approach. It only depends on your preference and the surgeon's preference.

I personally prefer the "closed" approach because it avoids any scar, even a well healed and inconspicuous one.

The most important factors you should consider are whether or not your surgeon is well qualified (i.e. Board Certified), if you feel comfortable and like your surgeon and if your surgeon has good before and after photos.

If so, then you will likely have a good result no matter which approach you use.

John Diaz, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Closed rhinoplasty is preferred

It appears that there is a bump on the nose and a large bulbous tip. Rhinoplasty can be done through either a closed or an open approach, although I would favor a closed approach. The price range on a rhinoplasty of this type would be approximately $6,000 including the operating room, anesthesia, and the surgeon’s fee. Any additional work on the internal portion of the nose for breathing such as the septoplasty and turbinate surgery would be additional, and is usually billed to the patient’s medical insurance out of medical necessity.

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

Type of Rhinoplasty for my crooked nose?


Thanks for including a picture of your nose. Your problem is not unique. You have many good options. Look at my other rhinoplasty responses so you can be prepared for your doctor visit.

The REAL keys are your expectations and the ability of the doctor. This requires communication and honesty on both ends. You should see more than one doctor.

You are on the right track by getting information - the next step is building trust with the Doctor that will do your procedure.

Michael Kulick, MD, DDS
San Francisco Plastic Surgeon
4.2 out of 5 stars 11 reviews

Rhinoplasty Approach for Crooked Nose

Hi Babu girl,

It seems from what you say that the hump and crookedness of your nose bother you. You need to consult with a qualified rhinoplasty surgeon and let her/him know exactly what bothers you and what result you would be pleased with.

Open or closed is an approach to your rhinoplasty. I would likely approach your nose through a closed technique with the possibility of converting to an open if necessary.

Your dorsal hump would be taken down, the upper 1/3 of your nose narrowed, and the lower 1/3 refined.

The price range varies depending on the surgeon and the geographic location.

Good luck and be well.

Dr. P

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

Rhinoplasty issues

Rhinoplasty can be performed using an open technique or a closed technique. Each surgeon is different. I think that the majority of surgeons would prefer to do it open. It makes more sense to visualize the structures directly and make adjustments under direct vision. I reserve a closed rhinoplasty for only very minor changes. It is like working on a car engine with the hood down and your hands under the hood without ever seeing the parts.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

You have several issues to address

You present with several problems, both functional and aesthetic that can be addressed by either approach. This would be finalized after a complete examination. You have fairly thick skin, a somewhat bulbous tip, dorsal profile irregularity, some deviation and a wide nasal base. In addition, you may have some internal nasal septal deviation, turbinate hypertrophy and may have some internal nasal valve weakness or dysfunction (previous trauma?) It looks like there may be some inherent weakness in the strength of the alar cartilages and some drooping of the tip (ptosis) as well. Definitely find an experienced Rhinoplasty specialist. Good luck.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews

See a rhinoplasty specialist.

 It makes little difference which type is done, open or closed. The important thing is you choosing an experienced rhinoplasty specialist who will weigh the advantages/disadvantages of both and choose the right one for you.

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

Open versus closed rhinoplasty for hump bump nose job

The choice of incision depends on the preference and experiences of your surgeon. Generally the open may allow more precision but it is typically associated with prolonged swelling and healing.

Costs for this surgery will vary tremendously and to some degree some of this may be partially covered by your insurance given your breathing difficulties.

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

Roughly - a closed rhinoplasty with a septal correction

Obviously, I need to see your nose - inside and out - to tell you exactly what has to be done, but this looks like a fairly straight forward nose for me where I correct the septum(inside) and the external deformity. I have been doing this over 30 years and do them closed ( no external incisions).

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