Crooked nose

A crooked nose is one where the bridge, the tip or both lean to one side. Some noses are crooked from birth, some after an injury, and some after earlier surgery. The American Society of Plastic Surgeons (ASPS) lists “nasal asymmetry” among the things rhinoplasty can address.

Straightening a nose is one of the harder jobs in rhinoplasty. The bones, the cartilage and the septum all have to be dealt with. This guide explains what a surgeon looks for, how the nose is straightened, and what you can honestly expect.

What makes a nose look crooked?

A nose looks crooked because the bony vault, the septum, the tip cartilages or a combination of them are off the midline. Cleveland Clinic says a severely deviated septum may make the nose look off-centre or the nostrils uneven. Causes of a deviated septum include being born with it, growth that leans the septum to one side (the most common cause), and injury such as a broken nose.

A paper comparing two techniques describes two common patterns: an I-shaped nose, which leans to one side along a straight line, and a C-shaped nose, which has a curve in the middle of the bridge.

Many crooked noses also cause breathing trouble on the narrow side. See breathing problems and a deviated septum.

How does a surgeon assess a crooked nose?

A surgeon assesses a crooked nose by looking at it from several angles, feeling the bones and cartilage, and examining the airway. StatPearls lists photographs from the front, both sides, three-quarter, from below and from above. It also lists an examination of the valves and an internal exam with a light, or an endoscope when needed.

The trial in PMC measured the lean from standardised photographs: for an I-shaped nose, the angle between the midline of the face and the line from the root to the tip. Your surgeon may do something similar so that before and after can be compared.

Ask the surgeon to tell you whether the bones, the septum or the tip is the main cause. The answer decides the plan.

Which technique usually treats it?

A crooked nose is usually treated with septorhinoplasty: the septum is straightened and the nasal bones are repositioned.

Osteotomies. StatPearls describes straightening with bilateral lateral osteotomies plus a transverse osteotomy at the root of the nose, and says intermediate osteotomies may be needed for severe deviation (3 mm or more). The bones are cut so they can be moved to the midline.

Septal correction. StatPearls mentions a septal extension graft, used as a “caudal septal replacement graft after resection of the deviated portion”. It also warns that failing to correct dorsal deviation or tip asymmetry beforehand can itself count as an adverse outcome. An article on revision surgery describes using cartilage grafts, including crushed or diced cartilage, to correct a deviated nose.

Why bone cuts matter. A randomised trial of 90 patients at one hospital compared double lateral osteotomy with asymmetric hump reduction by rasp. In straight (I-shaped) noses, the rasp group’s correction partly reverted by 12 months while the osteotomy group’s held. Revision was needed in 75.6% of the rasp group and 4.4% of the osteotomy group. Patients who had osteotomy reported higher satisfaction. It is a single-centre trial with one year of follow-up, and it excluded S-shaped noses and cartilage-based bending, so do not read it as a rule for every nose. It does suggest that a surgeon who plans to straighten a nose by shaving alone should explain why.

Open or closed approaches can both be used. StatPearls says the open approach exposes the whole cartilage skeleton and is preferred for tip work.

What result is realistic?

A realistic result is a nose that is clearly straighter, not a perfectly symmetric one. ASPS says everyone’s face is asymmetric to some degree, and results may not be completely symmetric. The goal is facial balance and correct proportion.

Healing can also pull a nose off-line. Cleveland Clinic describes a crooked appearance as a possible side effect of asymmetrical healing, and says swelling on one side only is normal in the first few weeks. So do not judge the result early. Cleveland Clinic says full results usually appear after one year. See swelling month by month.

If the nose is still crooked after a year, revision rhinoplasty is an option. StatPearls says revision is generally delayed 6 to 12 months after rhinoplasty so the swelling can settle.

What can go wrong?

A crooked nose carries the general risks of rhinoplasty, and a higher chance that something is not fully corrected. A single-centre study of 732 closed rhinoplasties found that deviated nasal bones and side walls were linked to higher odds of revision (adjusted odds ratio 2.68). Another paper reports that dorsal reduction can unmask a septal deviation that was hidden before. Read the risks and complications guide.

Straightening can also change breathing, for better or worse. Cleveland Clinic says breathing improvements after functional rhinoplasty are typically seen within about six weeks.

How to choose a surgeon

Choose a surgeon who explains the cause of your crookedness and shows results on similar noses. Ask what they will do if the nose leans again, and what the revision terms are. If you are unsure whether to see a plastic surgeon or an ENT surgeon, read plastic surgeon or ENT surgeon. Use questions to ask a clinic to prepare.

Next steps

Read about septorhinoplasty and then the recovery day by day guide.