Advice on Revision Rhinoplasty for my Still Very Crooked Nose

I had a reconstructive septorhinoplasty done in December 2009. My nose had been very crooked from about 14 years old. I was initially really happy with the results but after a lot of the swelling went down it seemed to shift back to the deviated position. I had biodegradable material in the septum that dissolve after six weeks. Also the cartilage on the opposite side of the deviation are deficient. I would really like some advice pls.

Doctor Answers 10

Revision of Crooked Nose

I'm sorry you've had a disappointing result  after your previous  surgery. Although it is difficult to get the ideal result when operating on a crooked nose i think you will have significant improvement if  you see an experienced revision rhinoplasty surgeon. Although I cannot make specific recommendations without reviewing the previous operative report and examining you, I always do revisions like yours using the open rhinoplasty technique.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Rhinoplasty Revision Treatment

If your nose is still crooked after rhinoplasty there can be several potential reasons. These include, (1) bad luck - your bones just didn't heal straight, even though they were put in a good position. Revision should help this. (2) septal deviation. A facial plastic surgeon will typically correct this, but other surgeons may not. You'll need a facial plastic surgeon to look inside your nose and see if the bony or cartilaginous septum is effecting the nose. (3) twisting of the tip of your nose - this can be caused by a number of factors.

Overall, you'll need to see someone who is an expert in revision rhinoplasty as these are challenging procedures. We see people from around the world with these issues and can often help, but there are qualified facial surgeons in most communities. Good luck!

Jeffrey H. Spiegel, MD
Boston Facial Plastic Surgeon
4.6 out of 5 stars 61 reviews

Recurrent septal deflection after revision rhinoplasty

Unfortunately, it is difficult to state whether the recurrent deflection is due to fibrosis from the healing process or an undertreated condition. You may require more rigid grafts such as a rib graft but this could involve substantially more complicated surgery.

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

Crooked nose after rhinoplasty

First, a crooked nose can be very challenging to correct. That being said, most patients should expect at least a 50-60% improvement in the deviation. I would consider another opinion. Tony Bull is a very well respected nasal surgeon in London.

Andres Bustillo, MD, FACS
Miami Facial Plastic Surgeon
4.9 out of 5 stars 115 reviews

Revision rhinoplasty

I am sorry that you think that your nose shifted.  It looks like the nose is off to the left but the photo has a weird reflection on it. It is always best ot be evaluated in person.  Absorbable material may not have been the best thing for you to correct your deviation.  But, even with striaghtening noses, they are never perfectly straight after surgery.  Usually they are straighter but not perfect.

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

Nose still crooked after rhinoplasty

Without knowing all the details regarding the surgical maneuvers performed, or knowing what your nose looked like preoperatively, it is difficult to know what might have caused your nose to become ( or remain) crooked after surgery.  You are now about 9 months postoperative, so most of the swelling should be gone.  The force of scar contracture under the skin is one of the factors that make rhinoplasty so difficult and challenging.  You should discuss your concerns with your surgeon to see what options are available.

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Advice on Revision Rhinoplasty for my Still Very Crooked Nose

Broadly speaking there are two types of crooked nose, The first, is one you were born with(congenital) where all components of the nose were altered as they develop; and the second, is due to trauma. The second type in most cases is easier because the nasal anatomy developed normally.

The guiding principle in my practice, however, is that with crooked noses there are no shortcuts. In other words, the rhinoplasty must be done open(except for isolated nasal bone deviation) and all nasal components must be taken down from the septum(starting from scratch), the septum straightening and then the nose reconstructed from top to bottom(nasal bones, mid vault and then nasal tip and base). Each layer must be performed carefully, ensuring surgical accuracy. Cartilage tends to warp, however, scoring, grafting and suture techniques should be able to control the majority of the warping tendency. Results never get better with time if they do not look good first on the OR table.

Hope this helps

Andrew Kornstein, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 15 reviews

Return of crooked nose

Cartilage does have memory and will return to its original curvature.  The resorbable PDS plates do not offer long-term support.  You may very well require a rib graft to help straighten your bridge.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Persistently crooked nose after rhinoplasty

Straightening a crooked nose is one of the most challenging goals of rhinoplasty. Postoperative swelling can hide how deviated your nose was after surgery initially or you may have had a shift when you were further along in healing.

Certainly, revision rhinoplasty surgery is a possibility. Ensuring the structural framework of the nose afterward is vital and may require cartilage grafts from the septum, nose or rib (can be determined after an examination). In my experience, addressing the deviation by essentially freeing up the various components and then rebuilding it in a straighter position has worked very well.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Revision rhinoplasty for crooked nose

There are many techniques for revision rhinoplasty that are used to improve and straighten the nose.

These involve both medial and lateral osteotomies to straighten the nasal bones and cartilaginous spreader grafts  to widen, spread, strengthen, and bolster the upper lateral cartilages on one or both sides. The spreader graft can also hold nasal bones outward when pinched inwards. Make sure your revision rhinoplasty surgeon has performed thousands of rhinoplasties and revision rhinoplasty procedures before embarking on this difficult operation. For many examples, please see the link below to our rhinoplasty photo gallery


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