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A crooked, asymmetric, or twisted nose is a very common revision rhinoplasty problem. Crooked noses will sometimes appear more so in photographs or when smiling. A crooked nose will typically also have two different profiles (i.e. the right profile and the left profile are different). The nose may have crooked bridge, crooked tip, crooked nostrils, or a combination of all. Crooked noses often also have functional (breathing problems) in addition to the cosmetic problems.
A crooked, asymmetric, or twisted nose may either be congenital (i.e. no previous rhinoplasty) or the result of previous surgery or injury. Many crooked noses also have a crooked or deviated septum and it is critical to correct the septal deviation at the same time as correcting the exterior of the nose so that the nose has a straight foundation (think of the septum as being a foundation on which the rest of the nose sits - if the septum is crooked many times so is the nose).
Some crooked and twisted noses result from removal of excessive amounts of cartilage during the initial rhinoplasty so that the nose becomes unstable and tends to lean and twist during the healing process, especially if there is deviation of the septum which was not properly addressed.
Nasal fracture can also result in a crooked nose. In children sometimes a fracture in childhood may be very subtle and not noticeable but as the child grows (and the nose grows) the degree of deviation increases.
A crooked or twisted nose is treated at first by correcting any deviation of the septum. The other crooked or twisted structures of the tip and bridge are often treated by a combination of maneuvers such as trimming, suture contouring, and cartilage grafting to reshape and reconstruct the nose into a more symmetric shape. The cartilage that is used for grafting typically comes from the septum, the rib, the ear, or a combination. If the nasal bones are also crooked, osteotomies (controlled fracture of the nasal bones) will also need to be performed to correct the bridge.
For most individuals 1 week is adequate recovery for returning to basic activities (work, school, driving, shopping). The nose will feel somewhat 'stiff' and swollen for some. This will improve and soften over time. Most of the swelling is typically gone in 1-2 months and the swelling and stiffness of the nose will continue to improve up to a year after surgery.
It is important to not sleep on the face for the first few weeks after surgery and a protective tape dressing is often worn nightly for a few weeks.