What do you think is the #1 complaint among patients undergoing nose revision surgery? It's not "nose too large" or "nose too low."By far, it's "crooked nose"(Aesthetic Surgery Journal, 2011).
Subtle asymmetry noticed in selfies. Nasal bridge misalignment that makeup can never hide. This "deviation" involves2 types of forces—and one of them can be caused by the surgery itself.
Mechanism of nasal bridge deviation
- The fundamental mechanism behind apparent nasal bridge deviation
- Nose structure: the role difference between hard bone and soft cartilage
- Causes of "intrinsic forces (foundation distortion)" and "extrinsic forces (pulling from surroundings)"
- Medical reasons for nasal bridge deviation after nose surgery
- Surgical approaches to straighten a crooked nose
"Nasal bridge deviation (deviated nose)" that bothers you every time you look in the mirror
The nose, located at the center of the face, is a crucial feature that determines the overall impression and balance of the entire face. Even slight misalignment of the nasal bridge or C-shaped or S-shaped curvature disrupts the symmetry of the entire face. This condition is called "deviated nose (shabi)" in medical terminology.
Deviated nose is not only an aesthetic issue but can also accompany nasal congestion and breathing obstruction. Straightening this "crooked nose" is considered high difficulty in plastic and cosmetic surgery.
In a paper by Dr. Block et al. (2022) published in 'Plastic and Reconstructive Surgery,' it states that "crooked nose is difficult to treat even for experienced surgeons." Because the forces bending the nose are complexly intertwined, there is a high likelihood of returning to the original state with only superficial treatment.
In their paper, Dr. Block and colleagues caution that treatment of deviated nose should be regarded as "reconstructive septorhinoplasty." To fundamentally correct nasal bridge deviation, "comprehensive treatment" by a specialist with thorough knowledge of nasal anatomical structure is required.
Nose structure: a 2-layer structure of hard bone and soft cartilage
To understand why the nasal bridge becomes crooked, it is important to understand how the nose is structured. The human nose is composed of "hard bone" and "soft cartilage."
- Nasal bone: hard bone covering from the root of the nose to the center of the nasal bridge, adhering tightly to the skull.
- Cartilage: soft tissue forming the nasal bridge from the center to the nasal tip. Parts called the upper lateral cartilage and lower lateral cartilage combine to create the shape.
- Nasal septum: the "wall" in the middle dividing the nostrils left and right, with hard bone at the back and cartilage at the front.
Nasal bridge deviation is caused by various forces acting on the "bone" and "cartilage." Cases include the hard bone bending, the soft cartilage twisting, or both being involved, and the condition differs from person to person.
Considering the causes of nasal deviation
The "deforming force" acting on the nasal bone and cartilage that causes nasal deviation can be divided into 2 categories: "intrinsic force" and "extrinsic force."
Intrinsic force: distortion or fracture of the nasal septum itself
Intrinsic force originates from the nasal septum itself, which is the foundation of the nose, and includes "nasal septum fracture" and "damage to the quadrangular cartilage." Due to impacts in childhood or forces during childbirth, the nasal septal cartilage may become distorted during the growth process.
Extrinsic force: pulling from surrounding tissues
Extrinsic force originates from tissues surrounding the nasal septum, including adhesion from cartilage tissue, compression from skin, and scar contracture from past injury or surgery.
As a result, the position of the nasal septum shifts, and deviated nose can occur.
Reasons for nasal bridge deviation appearing after cosmetic surgery
Some people have the concern that "immediately after my first nose surgery it was straight, but over time my nasal bridge became crooked." In cosmetic surgery, there are many cases where past surgery causes nasal deviation.
In a paper by Dr. Chauhan et al. (2011) published in 'Aesthetic Surgery Journal,' patient dissatisfaction in initial and revision surgery is analyzed. Patient dissatisfaction in initial surgery often concerned "nasal dorsal hump" or "nose too large," butthe #1 complaint of patients seeking revision surgery was "crooked nose"(38%).
The cause of deviation after surgery is "extrinsic force"Scar contractureor excessive cartilage removal. Scars created by surgery have a tendency to contract, which can pull the cartilage and cause the nasal bridge to become crooked.
Surgery to straighten a crooked nose
How can a crooked nose be beautifully corrected?
In a 2022 paper by Block et al., the importance of using an open approach to 'actively release' the deforming forces that bend the nose is described. It is necessary to remove all adhesions that are pulling and reduce the tension in the curved cartilage to zero.
The paper also states that 'minor adjustments alone make long-term correction difficult.' After removing all the causes, the procedure transitions to 'systematically reconstructing the framework using straight and rigid cartilage grafts.'
Research into the latest surgical techniques is also progressing.
- Central reconstruction using asymmetric grafts: In a 2019 paper by Chen et al. published in 'Annals of Otology, Rhinology & Laryngology,' the effectiveness of a technique to create a new center by applying a graft to only one side of a deviated nasal septum is reported.
- Caudal septal division and batten graft insertion: In 2019, Dr. Kim and Dr. Jang introduced a technique of cutting the curved L-shaped cartilage and inserting another cartilage (batten graft).
As described, correcting a crooked nose requires a specialist with anatomical knowledge using advanced techniques.
Key points to know
Here are the main points to remember about nasal bridge deviation (crooked nose).
- The causes of a crooked nose fall into two patterns: 'distortion of the foundation (nasal septum)' and 'pulling from surrounding tissues'There are cases where the main structural cartilage inside the nose is bent, and cases where surrounding scars or cartilage pull on it.
- Crooked nose trouble after rhinoplasty is commonThe 'contracting force' of scars from past surgery can pull the cartilage, causing the nose to become crooked.
- Correcting a crooked nose is challenging even for professionalsSurface treatment alone is of limited effectiveness; complete reconstruction is necessary.
- Choosing a clinic with medical evidence is importantDeviated nose correction is a technically advanced field, and selecting an appropriate specialist is crucial.
To identify the precise cause of nasal deviation and develop an optimal treatment plan, consultation with a specialist is essential. If you have concerns about nasal asymmetry or changes after surgery, we recommend a consultation.
Our clinic offers individualized treatment plans. For details, please seeTreatmentsFor more information, visit ourcolumn listwhere we also provide other beauty care information.
Author of this article
Tetsuo SakuPhysician
Director, SUNSET Medical Corporation — Zetith Beauty Clinic Ginza, Osaka, Fukuoka
Specializing in rhinoplasty based on anatomical evidence, with annual case numbers among the top in the industry. Known for surgical design that emphasizes structural support and an approach that pursues long-term stability.
References
- Block L, Pfaff M, Harris A, et al. The Crooked Nose: A Practical Guide to Successful Management. Plastic & Reconstructive Surgery. 2022 (DOI)
- Jalalabadi F, Bellamy J, Rohrich R. The Key to a Straight Nose Is a Straight Septum: 10 Essential Steps. Plastic & Reconstructive Surgery. 2023 (DOI)
- Jalalabadi F, Bellamy J, Rohrich R. The Key to a Straight Nose Is a Straight Septum: 10 Essential Steps. Plastic & Reconstructive Surgery. 2023 (DOI)
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