In many ways, the very challenging correction of the twisted or broken nose can be viewed as the final step in the mastery of rhinoplasty. It challenges the great surgeon to restore the various deformities present using a detailed understanding of both cosmetic rhinoplasty and functional reconstruction. This is because septal deviation or septal fracture is very common with twisted and/or broken noses and its correction, in large measure, determines the long-term success in treatment of the associated crooked cosmetic deformities. That is why oftentimes, people who have broken their noses and had them treated in the emergency room, long term end up with a still crooked nose- the bones were straightened but because the septum was not, over time the nose twists.
Oftentimes, surgeons treating the crooked nose fall into one of two camps, those who attempt to simply “camouflage” existing deformities and those who attempt to restore and reconstruct the pre- injury state. Rarely, following acute trauma where minimal or no functional problems are present, we can use cartilage grafts to restore the pre-injury straight appearance. These thin slices of cartilage are placed over areas of depression or curvature to hide the contour irregularities. The irregularities themselves are left uncorrected. However, while camouflage techniques preserve maximal support, they may lead to a nose that is overly prominent and wide. That is why, in general, we also do not use or recommend injection rhinoplasty in these patients- it can make your nose too wide.
For most patients presenting with broken or crooked noses there is a vague history of previous trauma, often during childhood, which was not treated and eventually led to a twisted nose. Oftentimes in correcting the twisted tip or asymmetric nostrils, we have found that it is the deviated or fractured septum that is the main cause and not the broken bones. Reconstruction provides optimal aesthetics in these cases because it not only allows us to make the nose look straighter but also to restore the underlying framework to its normal pre- injury positions. This approach is balanced and allows us to address each cosmetic concern while maintaining and maximizing long-term support and function.