How to Repair Twisted Cartilage

The correction of a "crooked" or "C-shaped" nose is perhaps the most complex type of nasal surgery, particularly when this crookedness occurs in the lower half of the cartilaginous portion of the nose.

How to Repair:


Correcting the "parrot beak" that is developing may also contribute to correcting the crooked look of your nose. Adjustments to improve the "parrot beak" would entail reducing the height of your nasal dorsum, also increasing the height and improving the contour of your nasal tip.

Scoring of the native cartilage in that region will also help.

Placement of a "spreader graft" between the upper lateral cartilage and the septum in the middle vault area of your nose will also aid in maintaining the straightened contour of your nasal dorsum.


You'll need a consultation with thorough examination by a facial plastic surgeon to fully asses the best approach to achieve your aesthetic goals while simultaneously ensuring optimum nasal breathing function.

The best way to repair twisted lower cartilage is usually with osteotomies and a spreader grafts.  Osteotomies are used to straighten nasal bones and spreader grafts are used to straighten out the midthird of the nose and upper lateral cartilages.  This involves using a piece of patient’s own cartilage from either the nose or the ear and inserted up underneath the concaved upper lateral cartilage and skin to tent out that area.

From your pictures it appears that at the time of taking down the bone the lateral cartilage on the left may have been separated from the nasal bone creating an  indentation just below the bone on the left.  In addition there is prominence of the septum in your side view which is creating the fullness in the side view. 

I feel the best approach would be an open rhinoplasty taking down bone and cartilage in the central third and placing a spreader graft on the left to lift out the left lateral cartilage and realign it with the nasal bones.  Lastly, I would address the fullness in the tip cartilages.  

This is a situation where computer imaging may help you to better appreciate this correction.

The cartilage and bone in a nose need to interrelate in a smooth transition. Under the skin the upper one third of the nose is bone and the lower  two thirds are cartilage. It looks like there is an "inverted V" problem in which you can see the bone above and then you can see that the cartilage lower down has separated or collapsed in. This usually requires spreader grafts, and in the case of a twisted nose, also osteotomies or a rearrangement of the nasal bones. The tip cartilages look slightly asymmetric and probably will require suturing. The septum may be contributing to the twisted look and needs to be examined for internal deviation. The lower fullness on profile can be reduced at the same time as the other surgery.

The photos are slightly out of focus but it looks like a c-shaped septal deviation concave to your left. That is usually addressed by removing a window of cartilage from the septum inside your nose. There are likely other issues that need to be addressed but cannot be discerned from these photos alone.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

The twisting of your lower nose is due to warping and displacement of the septal and lower lateral cartilages of the nose.  This can be address with a septoplasty and rhinoplasty.  Consult a board certified plastic surgeon.

All the best,

Talmage J. Raine MD FACS