What's up with the crooked end of my nose? Is it possible that this snuck up on me? (photos)

When surgeons look at the nose, we think of it in "thirds" the upper bony third, the middle cartilage third and the lower tip third. When we think about the causes of crookedness, there are a few main causes. One is traumatic (like a bad hit to the nose! one is congenital/development (your body grows that way, like a septal deviation) or another is due to surgery/healing. However, what can complicate this is that sometimes its not that it is crooked, but that your nose is asymmetrical giving it the impression that it is crooked. Its difficult to know from your photo where the actual problem lies and you really need to see a good surgeon to evaluate this. I live in Ottawa and worked in Toronto. If you are curious about some surgeons in Toronto, feel free to write me and I'd be happy to give you some advice. James P. Bonaparte, MD, MSc, FRCSCOtolaryngology - Head and Neck SurgeryFacial Plastic and Reconstructive SurgeryOttawa, Ontario, Canada 

I would have to examine the septum and the tip to make a recommendation.  I would
search for the
board certified plastic surgeon who you
feel is most likely to give you
the best results and who performs hundreds of these procedures each
year. I would look at reviews and before and after pictures on that
surgeon's website. Kenneth Hughes, MDLos Angeles, CA

 It is difficult to tell from only one photograph what is going on, but there appears to be either congenital or traumatic injury to the cartilages of the nasal tip area and there appears to be an inverted lower lateral cartilage and a concave upper lateral cartilage on the patient's right side. To repair this, there are multiple  maneuvers that are performed during a surgical rhinoplasty  in order to make the tip more symmetrical. Cartilage grafting techniques  are used which involve harvesting cartilage from the inside of the nose and  placing these grafts to match the cartilage structure of  the opposite side. A spreader graft would be required to be placed underneath concave upper lateral cartilage as well  as an onlay graft across the inverted tip cartilage.  For more information and many examples, please see the link and the video below

Dear Queen1965,

From
the clinical photograph, there appears to be some noticeable asymmetry of the
soft tissue, cartilages and skin at the
end of the nose. This could have been
developmental, traumatic and it would have be unusual to be slowly
developmental.

Regardless
of the etiology, as long as it has stabilized and it has not progressed, there
are several options. The simplest option
would be use of soft tissue filers, such as Juvéderm® Voluma™ to recreate more
definition, refinement and symmetry at the end of your nose. Surgical correction can be performed under
local anaesthesia and involves repositioning the cartilages and stabilizing
them in place for long-term correction.

Having
trained in both plastic surgery and ear/nose/throat-head and neck oncology, I
have been performing cosmetic rhinoplasty, as well as injection rhinoplasty,
for over 20 years. I have found during
the consultation that performing computer imaging to show patients the range of
improvements that can be achieved is very helpful in patients deciding whether
to proceed and what kind of aesthetic enhancement they want to proceed with.

For
more information, please review the link below.

I
hope this information has been of some assistance and best of luck.

Sincerely,

R.
Stephen Mulholland, M.D.

Certified
Plastic Surgeon

Yorkville,
Toronto