Crooked Nose

The crooked nose can broadly be due to 2 main causes, congenital or developmental (that is the patient was born with a crooked nose) or acquired (usually as a result of an old injury to the nose). The crooked nose is an aesthetic as well as a functional problem. Aesthetically the crooked nose perturbs the balance of the midface, bringing unwanted attention of the observer to the nose, detracting from other facial features. Once corrected, this balance is restored and a profound improvement of the overall facial aesthetics can be achieved. As importantly is the functional aspect of the nose. The crooked nose often results in partial blockage of the nasal passages, causing significant patient discomfort and difficulty breathing.

Correction of the crooked nose is very challenging, with the need to simultaneously balance the need to straighten the nose with the equally important priority of opening the nasal airway. Other aspects that one wish to address at the same time can off course be address, such as a higher nasal bride or increasing the tip projection. From an anatomical point of view, the deviation is not located at one spot but involve several components of the nose. These must be precisely addressed individually to achieve the desired straightening. The nasal bone, nasal cartilages, the central support formed by the septum (which has a bony as well as cartilageneous component) and the turbinates inside the nose which regulate airflow in the nose must all be addressed.

Figure 2: A saddle nose as a result of nasal fracture.
The approach required therefore varies from individual to individual depending on the degree or severity of the injury. An open approach (which requires a small incision under nose, in the collumella of the nose. This incision heals very well and becomes inconspicuous with time) is generally required as this access will give the precision needed to reposition the various components of the nose. If the bone is crooked, precisely fracturing the bone to reposition in the midline is needed. The central strut of the nose, the dorsal septum, as well needs to be re-positioned in the midline by various techniques. The nasal cartilages can be reshaped and repositioned as needed to refine the aesthetics of the nose. Often, especially in the ASIAN nose with thick skin and generally thinner cartilages, additional cartilages is needed to reinforce and secure the structures in the midline. The use of your own cartilage is often the best option over the long term for its safety and longevity (compared to foreign material like silicone). The cartilages when needed can be safely harvested from the ear or chest with minimal scarring. Finally the turbinates needs to be addressed to ensure that the shifted nasal structures do not block the nasal passages.

The nose is placed in a splint to prevent structures from shifting in the early post-operative period. These can be taken down at a week and the stitches removed. Recovery takes 2 to 3 weeks, with the swelling gradually subsiding. The swelling generally reduces incrementally, more quickly at the top of the nose, taking just several weeks with the tip of the nose taking the longest as the skin is the thickest (up to 6 months).