Straightening a crooked nose.

A crooked nose is one whose axis deviates from the middle of the face. The deviation can affect the bony bridge, the cartilaginous part or the nasal tip — often a combination of these. Because the nose sits at the centre of the face, even a small deviation is clearly noticeable.

The causes are varied: some crooked noses are constitutional, others arise from a blow or a fall, others again remain after previous surgery. Very often the septum is deviated at the same time — which affects not only the shape but also nasal breathing.

The nasal septum is a plate of cartilage and bone standing vertically in the middle of the nose. It separates the two airways — and it supports the nose bridge from within. This second detail explains why a crooked nose is so rarely a matter of shape alone.

Cartilage is under tension. If the nasal septum is deviated, it pushes the nose bridge continuously to one side — like a bent pole pulling a tent out of true. Straightening only the outer nose and leaving the septum untouched means working against that tension. Over the months it frequently reasserts itself. This is precisely why correcting a crooked nose without treating the nasal septum is an uncertain undertaking.

Then there is function. A deviated nasal septum narrows one side of the nose and impairs breathing — often so gradually that those affected consider it normal and only notice after the operation how much air had been missing. The two therefore belong together: we always plan the correction of a crooked nose starting from the nasal septum.

That does not mean the septum is simply removed. It is the supporting structure of the nose; a marginal strip always remains in place. Straightening is achieved by releasing the tension in a targeted way, by realignment and, where necessary, by supporting elements made from the cartilage obtained in the process.

We work extensively with the modern nose-bridge-preserving technique, known as dorsal preservation, and with hybrid techniques — not exclusively with the traditional structural septorhinoplasty. The natural nose bridge is preserved rather than being removed and rebuilt. The result looks particularly natural, it is stable in the long term, and the risk of later irregularities on the nose bridge is reduced — which counts above all with thin skin. Certain forms of crookedness also recur less often.

That last point is the decisive one for this page. In the classical approach the nose bridge is opened and then reassembled; the straightened line is a reconstructed line that has to be held against the pull of the surrounding tissue. With the nose-bridge-preserving technique the bridge remains intact as a naturally grown unit and is aligned as a whole — there is no join at which a deviation could reappear.

This does not make the technique superior in general. With very pronounced S-shapes, with a severely deformed nasal septum or where material is lacking after previous surgery, a structural reconstruction is the better solution. Often the best route is a hybrid technique: part of the nasal bridge is preserved while other structures are modified in a targeted way — the advantages of dorsal preservation remain, with a wider range of application.

Whichever route is chosen, the correction of a crooked nose usually involves these steps: the nasal septum is released from its tension and realigned. The bony base is centred through precise cuts in the nasal bone — using the piezotome, the ultrasound instrument that works on bone without injuring soft tissue, mucous membrane and blood vessels; control over the line of the fracture is considerably greater than with chisel and saw. The middle third of the nose is held with narrow strips of cartilage, often of differing thickness because they have to compensate for an asymmetry. And the nasal tip is stabilised with cartilage support, so that it does not return to its old direction.

A deviated nasal septum almost always narrows one side of the nose. Because this has usually been the case since childhood, those affected regard it as normal — they have never known anything else. Typical signs are: breathing through the mouth at night, waking up with a dry throat, running out of breath sooner during exercise, constantly using decongestant nasal sprays, always getting too little air on the same side.

During the examination we therefore look at the nose from the inside and assess the narrow points individually: the nasal septum, the turbinates, the internal nasal valve between the nasal septum and the upper lateral cartilages, and the external nasal valve at the nostrils. Each of these points is treated differently, and with a crooked nose several are frequently affected at once.

For you this has a practical advantage: shape and breathing can be corrected in a single procedure — one anaesthetic, one healing phase. What does not belong to the nasal skeleton, however, does not belong to our field either: allergies and disorders of the sinuses are investigated together with an ENT specialist, so that you do not expect an operation to improve something that has a different cause.

A rhinoplasty with us takes one to four hours. That range is deliberate: we operate in our own operating theatres and therefore without time pressure — for as long as it takes until every detail is right. How long a procedure takes is decided by the findings, not by the schedule.

The crooked nose is among the findings that tend towards the upper end. Straightening a nasal septum is millimetre work on a material that is under tension and keeps striving back towards its old form. The bony base has to be aligned so that both sides match. And then comes the stabilisation, which frequently has to be built asymmetrically because the two sides need differing amounts of counter-support.

Between these steps we check again and again: from the front, from the side, from below. These loops of checking are the reason we do not save the last half hour — with a crooked nose it decides whether the nose looks straight or almost straight.

A crooked nose is rarely crooked only on the outside. What you see in the mirror is the consequence — the cause usually lies within, in a nasal septum that is under tension. Straightening a crooked nose is therefore almost always a larger procedure than a purely aesthetic reshaping, even when the visible deviation appears small.

Breathing often improves more than expected. Many of those affected consider their restricted nasal breathing normal, because they have known nothing else since childhood. The difference after healing is then frequently the part of the result that is talked about most — more than the straight nose itself.

Patience is part of the procedure. With no other correction is the interim state as uninformative as with the crooked nose, because the swelling subsides unevenly. We therefore accompany you over months with regular check-ups and compare the axis with the photographic documentation each time.

Constitutional. The nose does not grow entirely evenly. If the nasal septum grows faster than the frame it sits in, it gives way — and takes the nose bridge with it. Crookedness of this kind usually shows itself in puberty, when the nose goes through its last growth spurt. The tissue is unscarred, the structure intact, and the planning correspondingly predictable.

After an accident. A blow from the side displaces the nasal bones against one another; if they heal together out of alignment, the deviation remains. Very often the nasal septum has been injured as well — it buckles with the same impact and is thereafter part of the reason for the crookedness and for the restricted breathing. Many broken noses from childhood go unnoticed and are taken for a harmless knock; the nose then continues to grow crookedly. For the operation this is no disadvantage — what matters is today's findings.

After previous surgery. Scar tissue contracts over months, and it rarely does so evenly. A nose that sat straight after the procedure can thereby drift to one side over the course of a year. Here it is less a matter of removing tissue than of building up, and of a stabilisation that is stronger than the pull of the scar tissue. Four in ten nose operations at the Kuzbari Centre are revision rhinoplasties on a nose that has already been operated on; we take such cases on deliberately.

Why this counts for the planning: a constitutional crooked nose needs above all a clean straightening. A nose after a fracture additionally needs the bony base to be aligned. And a nose after previous surgery needs more material, more stability and more patience during healing — here the final result tends to be reached at twelve to eighteen months.

After a fresh fracture there is a short window of a few days in which the bone can be realigned without a major procedure. Once it has passed, one waits until everything has healed and then corrects the crookedness, the nasal septum and any hump afterwards in a single planned procedure. That is no disadvantage: a planned correction generally leads to a more precise result than an immediate measure.

Age. For aesthetic indications we operate once facial growth is complete — in women generally from around the age of 16, in men somewhat later. If a marked obstruction of breathing is the main concern, a correction may make sense earlier; we then discuss this on an individual basis. There is no upper age limit.

Calendar. Allow for two to three weeks in which you do not have to be in the public eye. And expect the axis to be reliably assessable only after some months, because the swelling subsides unevenly at first. If you are working towards a fixed date, allow generously — at least eight months.

An initial consultation with three-dimensional simulation, a technique that suits your nose, and an operating time that follows the findings — this effort is the reason why rhinoplasty with us has its price. It is also the reason why the result is meant to hold: for a lifetime, not for a few years.