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FAQ: Rhinoplasty for Crooked or Twisted Noses

1. How does rhinoplasty for crooked or twisted noses differ from standard rhinoplasty?
While over 85% of people have significant facial asymmetry, a nose that is awkwardly twisted, tilted or crooked may create aesthetic or physiological problems. Anatomic reasons for a crooked nose or a twisted nose or a C-shaped nose include asymmetric nasal septum (known to many as a deviated septum), asymmetric nasal bones, asymmetric middle vault cartilages (Upper Lateral Cartilages), asymmetric tip cartilages (Lower Lateral Cartilages), asymmetric alar rim length (nostrils) or significantly asymmetric facial bones. Clinical reasons for a crooked or twisted nose include developmental issues, trauma to the face or a poorly performed prior rhinoplasty. While the surgical techniques are similar to those used in other types of rhinoplasty, rhinoplasty for crooked or twisted noses are often more intricate.

2. Is crooked nose rhinoplasty more painful than other types of rhinoplasty?
A crooked nose is corrected through a traditional rhinoplasty technique that sometimes includes placing spreader grafts in the middle third of the nose. A crooked nose does not necessarily make the rhinoplasty any more painful than the traditional procedure. While the nasal bones usually have to be reset through a process called an osteotomy, that is not any more painful than other surgical techniques.

3. Are there many different types of crooked or twisted noses?
Surgeons who have familiarity with crooked noses are usually able to differentiate between commonly associated anatomical abnormalities. Asymmetric noses are generally characterized by deviation of the bony upper third and/or the cartilaginous lower two thirds of the nose. Though crooked noses vary from person to person, a nose that is not straight usually involves a deviated septum, middle vault asymmetry and a twisted tip.

4. What techniques are used in a rhinoplasty for crooked or twisted noses?
Correction of a twisted nose poses one of the greatest challenges in septorhinoplasty, as the surgeon's first task is to determine the cause of the asymmetric nose in order to plan surgical correction. To develop an appropriate surgical plan, a physical must determine whether the nasal asymmetry is a result of structural deformity, facial trauma or disease of the septum or internal nose.

In the event of a structural deformity due to injury or blunt trauma, the surgical technique used will vary depending on the severity of the injury to the nasal bones. Nasal fractures require less complicated techniques than nasal trauma associated with septal fracture, which requires a more extensive repair process.

When a problem is physiological, resulting from infection or immunologic disease, it is important that the surgeon identify a correct diagnosis, lest the anatomic abnormalities will recur or progress following surgery.

5. Can a twisted or crooked nose be corrected to make it 100 percent straight?
Although, a crooked nose can be significantly improved, it cannot be made 100 percent straight. The nose is composed of cartilage and bone which have natural irregularities and shapes. The nasal cartilages may have depressions and irregularities which can be improved with grafts. Additionally, the nasal skin itself has irregularities and areas with larger pores and other areas with thinner skin. These three different elements, the bone, cartilage, and overlying soft tissue and skin make it impossible to completely correct the crookedness.

6. What is the recovery time for rhinoplasty for crooked or twisted noses?
The recovery time for rhinoplasty performed on crooked noses is approximately the same as the recovery time for traditional rhinoplasty – approximately one week. Dr. Rizk’s patients benefit from his surgical skill and the advanced 3D, high definition technology he uses while operating. His approach is more precise and patients do not experience the same level of bruising. They are in fine shape after one week. Most will be back at work with minimal swelling after just one week.