The nose can be divided roughly into thirds on the front view. The nasal bones comprise the upper third, the upper lateral cartilages (mid portion of the bridge) make up the middle third, and the tip is roughly the lower third. Each portion of the nose can be deviated to one side or the other, causing the nose to appear crooked. This represents another common issue that patients may face after previous rhinoplasty.
Deviation of the upper portion of the nose can occur if the nasal bones are pushed to one side or the other. This can result from trauma to the nose after surgery or shifting of the nasal bones back into their original, natural position. If this occurs soon after rhinoplasty, before the bones have healed, they can often be pushed back into a straight position with a procedure called a closed reduction. If the nasal bones are deviated and it has been greater than 6-8 weeks since a prior rhinoplasty or nasal trauma, the nasal bones can be straightened by fracturing them again. These controlled fractures (osteotomies) are performed very precisely through tiny incisions inside the nose.
If the middle portion of the bridge is crooked, this is generally the result of deviation of the upper part of the septum. This can give the nose a C-shape on front view. The other possibility is the position of the upper lateral cartilages, the cartilages which sit along either side of the bridge of the nose. Straightening the septum with sutures and supporting it with spreader grafts can be helpful for addressing deviation of this part of the nose. If one side of the middle portion of the nose is more concave than the other, either a thicker spreader graft or a double spreader graft can cause the nose to appear straighter. After surgery, periodically pulling the nose to one side with tape can be helpful.
Lastly, deviation of the tip can happen for a couple of reasons. The most common is deviation of the end of the septum. This deviation can push the tip complex to one side or the other. The other possibility is that the lower lateral cartilages could be asymmetrically shaped. Specifically a discrepancy in the length or strength of the lateral crura can be responsible. These are the portions of the cartilage that run above the nostril rims. Deviation of the septum can be repaired by reshaping the septum with suture techniques or shaving it back. Strengthening the lateral crura with strut grafts or shortening them with lateral crural overlays can be helpful if the cause of the tip deviation is the tip cartilages.
If you suffer from a crooked nose, contact Dr. Mehta today or a consultation!