I saw a patient today in consultation for a rhinoplasty and septoplasty. He was unhappy with his nose and he had great difficulty breathing. He never had any nasal trauma, but does recall that his nose was “perfect” until age twelve or so. Examination of his nasal cavity demonstrated a severely deviated septum to both sides and mild turbinate enlargement. On the outside, he had a very twisted nose. The bony upper one third of the nose was deviated to the right and then the middle third and the lower third, or tip, were off to the left. The lower two thirds, which are made of cartilage, were almost C-shaped. His tip was somewhat bulbous and droopy.
I began to explain him that I could improve his breathing a great amount by straightening his septum and reducing the size of his turbinates. I then went on to explain that I would narrow his tip just enough to improve it, while keeping it masculine. I would also strengthen it and raise it a small amount. I would then remove the nasal hump (bump) and straighten the bridge of the nose as much as possible. That’s when he stopped me. “What do you mean as much as possible”
Straightening a nose is the most single difficult thing to do in rhinoplasty, cosmetic nasal surgery. When a nose becomes deviated or crooked from trauma, it can usually be corrected fairly well. However, when the nose developed crooked, it may be impossible. The reason is that the bones may be completely different on both sides. Rhinoplasty surgery cannot correct this congenital deformity. Also, the middle third, which is made of cartilage, can be very difficult to straighten, as the cartilage can have memory. To correct this, we often use different types of grafts, such as spreader grafts to camouflage the deviation.
In conclusion, do not be alarmed or surprised if your rhinoplasty surgeon tells you that he cannot guarantee that the nose may not be perfectly straight. He is being honest. Be alarmed, instead if the surgeon guarantees a perfectly straight nose.