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The ‘crooked nose’, otherwise known as a misaligned nose, an asymmetric nose, a shifted nose, a twisted nose, or a broken nose, refers to a nose that appears “off-center” or deviates from the midline. Deviation or distortion of the bony or cartilaginous components of the dorsum can lead to a nose appearing crooked.  Nasal trauma is one of the most common causes of a crooked nose.  Abnormalities of the nasal bones, nasal septum, as well as nasal cartilage can result in a crooked appearance. 

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Asymmetry of the nasal bones can be corrected with nasal osteotomies. Nasal osteotomies are precise cuts that are made at the nasal bones, allowing for nasal bone mobility.  Once the nasal bones are mobile, they are then repositioned in a more symmetric fashion, allowing the nose to achieve a straighter appearance. Abnormal curvature of the dorsal septum can also lead to a crooked appearance. Septoplasty techniques as well as spreader grafts can be utilized to achieve a straighter appearance.  Caudal septal deviation can also lead to a crooked or “twisted” appearance of the nasal tip.  Many times, this can be corrected with a “swinging door” technique, where the caudal septum is repositioned at the anterior nasal spine, which is the anatomically correct position for the caudal septum.  In severe cases, septal replacement grafts can also be utilized for septal reconstruction.

These patients underwent rhinoplasty to correct the crooked appearance of their noses. Both noses deviated to the patients’ right prior to surgery, and this was very evident by the positioning of the nasal tip to the right of the midline of the upper lip. Note the marked improvement in nasal symmetry after surgery and the positioning of the tip directly over the midline of the upper lip.

Rhinoplasty: The Crooked Nose

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