Avoiding regret in deviated-nose surgery: why curvature recurs and nasal obstruction after surgery

Regret after deviated-nose surgery often stems from two issues: the straightened nose curving again (relapse), and nasal obstruction appearing after surgery. A curved nose typically has the bone, nasal septum, cartilage, and nasal tip all curved together, so correcting only part of it can leave curvature or allow it to return. It is important to confirm in advance how much correction is planned.

Why is deviated-nose surgery difficult to correct in one procedure?

Because the curvature is not in just one location. Studies report that in a curved nose, the nasal bone, nasal septum (the wall dividing the inside of the nose left and right), and upper and lower cartilage are often curved together[1]. In most people, curvature of the nasal tip, tilt of the nasal columella, and asymmetry of the nostrils are also seen together[1].

The curvature of the nasal septum varies as well—C-shaped, reversed C-shaped, S-shaped, reversed S-shaped, and more[2]. Therefore surgery combines bone-cutting to reposition the bone, nasal septum correction, cartilage adjustment, and improvement of nasal airway[1].

What is the most common cause of curvature relapse?

Incomplete bone-cutting. Textbooks identify incomplete bone separation as the most common complication. If bone does not move sufficiently, curvature can return or the broad nasal bone may not narrow adequately[3].

In contrast, research in which the same surgeon comprehensively reconstructed all parts of the nose showed that form was largely maintained through 24 months postoperatively, with only 1 case requiring revision surgery for partial recurrence[4]. However, this represents the results of a single surgeon with extensive experience, and the same outcome cannot be guaranteed elsewhere.

Why does nasal obstruction occur after surgery?

Because the nasal airway becomes narrower. Causes include over-narrowing of the nasal bone, the nasal mucosal fold (inferior turbinate) shifting inward, and airway valve collapse or narrowing from scarring[5].

When the nasal mucosal fold shifts inward and obstructs after bone-cutting, reduction of the fold may be considered[5]. In addition to appearance, how breathing changes is a point worth discussing before surgery.

Which patients are more likely to need revision surgery?

Patients who naturally tend to have nasal obstruction or whose nasal bones are curved are more likely to undergo revision surgery. In a study of 732 patients, revision surgery occurred in 8.6%[6].

The likelihood measure (odds ratio) was 3.30 for patients with nasal airway problems before surgery, 3.94 for those with broad nasal bone or side wall width, and 2.68 for those with curved nasal bone or side wall[6]. Revision rates for nasal surgery overall are reported as 5–15% in other studies[6].

How difficult is revision surgery?

Revision of a previously operated nose ranks among the most difficult types of nasal surgery[7]. Because it requires reconstruction while accounting for scarring and insufficient cartilage, determining how much to correct in the initial surgery is very important.

What to confirm during consultation

First, identify which of the bone, nasal septum, cartilage, and nasal tip are curved[1]. Second, understand how bone-cutting will be performed and how the result will be stabilized to prevent relapse[3]. Third, determine whether nasal obstruction currently exists and how breathing is expected to change after surgery[5][6].

The cause of curvature and what extent of correction is necessary cannot be determined without examining inside the nose. Clarify any concerns with your surgeon during the consultation.