Correcting a Curved or Broken Nose

Correcting a Curved or Broken Nose

Straightening a crooked nose

It is rather common to see patients whose noses are crooked and who come to plastic surgeons for nasal correction. These are patients who do not necessarily have a hump that needs to be made smaller nor a tip that needs to be made thinner—just a nose that needs to be straightened.

Causes for a crooked nose

  • Trauma
  • Genetics
  • previous surgery

Anatomy of the crooked nose

The nose can be misshapen due either to problems with bone or problems with cartilage sections of the nose.

Nasal bone problems

Usually a curvature in the nasal bones is due to trauma to the nose and breaking of nasal bones. Typically, a patient gets elbowed in the face during sports and the resultant bone is pushed off to one side. Commonly, the septum is also fractured in this type of injury.

Nasal cartilage problems

Crooked noses as a result of nasal cartilage malformation or injury fall into two groups.
  • Upper and lower nasal cartilages

These are cartilages that form the nasal tip. Trauma is usually one cause of upper cartilages being displaced and caving in . This gives an impression of a curved nose.

Lower cartilages are usually malformed from birth to give a curved nose.

  • Septal cartilage

The nasal septum is a thick cartilage that separates the two nasal sides. It is actually anchored onto the nasal bones superiorly, and at its base to a bone that forms the roof of the mouth, the maxilla.
A fracture of  nasal bones commonly leads to a fracture of the septum, which compounds the problems of a crooked look.
A septum can also be curved due to developmental reasons. Cartilage is like wood in some respects in that it will curve and bend with time. If curvature is in the upper two thirds of the septum, the whole nose will look off-center; if only in the lower third (caudal septum), just the tip looks funny. You can actually see curvature of the lower part in the nostrils. One side of a nostril may look smaller than another.

Corrective surgery for a crooked nose

Fixing nasal bones

Since the problem of a curved nose is due to either bone, cartilage or both, the corrective surgery must address the damaged anatomy.
A simple fracture of the nose can sometimes be corrected immediately by pushing the bones back into place! We’ve all seen that in boxing movies where a coach does that.
If you wait more than a few hours, then you are better waiting for about 4-7 days to allow some of swelling to decrease before attempting to set the fracture. After ten days, fractured bone will start to heal itself and surgery is not a good idea as the tissues are too inflamed. The surgeon should wait about two months before going in to set the nose.

Fixing nasal cartilages

Correction of a septal fracture involves either:
  • weakening the cartilage to shape it back into position (septoplasty); or
  • removing the fractured segment altogether (sub-mucous resection).

Correction of upper lateral cartilage

This procedure may require the removal of a graft of cartilage from the ears, crushing the cartilage so there can be tissue growth and placing a cartilage graft over the area to be filled.
Cosmetic surgery for correction of the crooked or curved nose can take up to two hours under general anesthesia, but that is the path to the straight and narrow.
For more information, follow this link to my web site: https://www.tavmd.com/nose_surgery.html

Morad Tavallali, M.D., FACS