Crooked nose: causes, types of deviation and how it is corrected

A crooked nose is one of the most frequent reasons for seeking rhinoplasty. Sometimes it is noticeable straight away from the front, other times only in photographs or in the mirror in a certain light. And often it is not only an aesthetic matter: a nose that is deviated on the outside usually also has a deviated septum on the inside, which makes breathing difficult.

In this article we explain why the nose becomes crooked, which types of deviation exist, when it can be corrected without surgery and how the correction is performed at Clínica do Nariz e Face, for rhinoplasty in Porto and rhinoplasty in Braga.

• Injuries: a blow, a fall or a sports accident, even in childhood, can deviate the bones or cartilage of the nose. Often the person does not even remember the episode.
• Growth: the nose grows until the end of adolescence and can develop asymmetrically, especially if the septum grows deviated.
• Previous surgeries: a poorly consolidated rhinoplasty or septoplasty can leave the nose deviated. In these cases we talk about revision rhinoplasty.
• Facial asymmetries: small differences between the two sides of the face make the nose look more crooked than it is, and have to be taken into account in the planning.

• C-shaped deviation: the bridge curves, like a C, from top to bottom.
• I-shaped or linear deviation: the whole nose is tilted to one side, but straight.
• S-shaped deviation: the upper part goes to one side and the lower part to the other.
• Tip-only deviation: the bridge is straight, but the tip points to one side, because of the cartilage or the septum.

Each type requires a different strategy. That is why the correction of a crooked nose is considered one of the most demanding rhinoplasties.

The nasal septum is the central structure that holds up the nose. When the nose is crooked on the outside, the septum is almost always deviated on the inside. This can cause a blocked nose on one side, snoring, mouth breathing or frequent sinusitis.

Correcting only the outside is rarely enough: if the septum remains deviated, the nose tends to become crooked again. That is why the correction of a crooked nose is often a septorhinoplasty, which treats shape and breathing in the same surgery.

In very mild cases, hyaluronic acid can disguise small irregularities and give the illusion of a straighter nose. But it does not correct the actual deviation, does not improve breathing and the effect is temporary. When the deviation is in the bone or the septum, the only way to correct it permanently is surgery.

The plan depends on the type of deviation, but as a rule it involves three steps:

• Straightening the septum: it is the basis of everything. A centred septum supports a straight nose.
• Repositioning the bones: with ultrasonic rhinoplasty, the bone is shaped with millimetre precision, with less swelling and less bruising than with traditional techniques.
• Balancing the cartilage and the tip: small cartilage grafts, usually from the septum itself, are sometimes used to align and stabilise the nose.

The surgery is performed under general anaesthesia and, in most cases, you go home the same day, one to one and a half hours later. The patient breathes through the nose from the end of the surgery, without the traditional packing.

The goal is a nose aligned with the middle of the face, with soft lines and free breathing. In very marked deviations, the result is a great improvement, but a small residual asymmetry may remain, because the face itself is never perfectly symmetrical. The final result settles over about a year.

See a real case of a hump, drooping tip and crooked nose in rhinoplasty before and after, and other results in our clinical cases.

I broke my nose recently. Should I have surgery now?

In the first few days after a fracture, it is sometimes possible to reposition the bones without open surgery. After that stage, the usual approach is to wait a few months for the nose to consolidate and only then have the rhinoplasty.

From what age can a crooked nose be corrected?

For the aesthetic part, it is best to wait until the nose has finished growing, around 16 to 18 years of age. Serious breathing problems can be assessed earlier.

Can the nose become crooked again?

The risk is greater when the septum is not corrected. That is why the assessment and correction of the septum are part of the plan whenever necessary.

Can I see how I will look before deciding?

Yes. At the consultation a Crisalix 3D simulation of the intended result is made.

How much does it cost to correct a crooked nose?

It depends on the type of deviation and whether breathing also needs correcting. The quote is defined after the consultation. We explain what affects the price in how much does rhinoplasty cost.

At Clínica do Nariz e Face, rhinoplasty is performed by Prof. Dr. Miguel Gonçalves Ferreira, a specialist in Otolaryngology, Head and Neck Surgery, who assesses the shape of the nose and the breathing in the same consultation. The consultation can take place at our rhinoplasty in Porto or rhinoplasty in Bragapractice. Find out what the first consultation is like.

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This article is for information purposes only and does not replace a medical consultation.