Who is a good candidate for deviated nose surgery? Consider nasal obstruction and facial asymmetry

Deviated nose surgery is suitable for people whose nasal deviation stems from a bent nasal septum (the internal partition), and who want to correct both appearance and nasal obstruction together. In people with facial asymmetry, even straightening the nose alone may not appear straight. It is also important to know in advance that this surgery cannot guarantee a completely straight nose.

Where does nasal deviation come from?

In most cases, deviation of the nasal septum—the partition inside the nose—forms the underlying basis. It is reported that external nasal deviation and septal deviation often occur together[1].

Textbooks explain that septal deviation is the central issue, with mid-bridge and tip deviation occurring as a consequence[2]. For this reason, deviated nose surgery combines five procedures: realigning bone by cutting it, straightening the nasal septum, correcting cartilage curvature, straightening the tip and columella, and adjusting nasal folds (inferior turbinates)[2].

Is this suitable for people with nasal obstruction?

People with nasal obstruction are good candidates for correcting both appearance and function together. It is considered that deviated nose surgery should address both aesthetics and nasal airflow[1]. In a study of 30 people undergoing surgery for external appearance concerns, 21 (70%) were troubled by both appearance and nasal obstruction[3].

Even without nasal obstruction, septal surgery may be necessary to straighten the external shape[4]. Conversely, small changes during surgery can alter airflow inside the nose, creating nasal obstruction[1]. Having an examination of the internal nasal condition before surgery provides reassurance.

For people with facial asymmetry, how much will change?

The greater the facial asymmetry, the harder it becomes to create a nose that appears straight. It is reported that when facial asymmetry exists, a straight-appearing nose cannot usually be achieved[5].

The nose itself may also be difficult to make completely straight[4]. This is because scar contracture and the cartilage's tendency to revert to its original shape affect the final result[4].

Does the extent of deviation affect the size of the surgery?

Yes. Most nasal septal deviations fall into one of four categories: C-shaped, reverse C-shaped, S-shaped, or reverse S-shaped[6]. C-shaped and S-shaped deviations tend to result in more complex surgery, so identifying them at the planning stage is important[6].

At one facility, mild deviations were corrected through an intranasal approach (closed technique), while twisted noses, severe deformities, and S-shaped deviations were treated with a method that cuts the columella (open technique)[7].

Which is better—open or closed technique?

Complex deviations favor the open technique, but comparative studies remain small. In a study comparing 30 patients, aesthetic satisfaction was 80% (12 of 15) with open technique and 60% (9 of 15) with closed technique[3].

In the same study using closed technique, 4 patients (26.7%) had residual deviation and 3 (20%) developed nasal obstruction[3]. However, this was a study of 15 patients each, with follow-up of 7–12 months[3]. In another study examining 50 patients, the results of the two methods were roughly equivalent, with outcomes heavily influenced by surgeon skill[7].

What to confirm before surgery

There are three reference points to consider. First, whether the deviation's source is the septal, bone, or cartilage component[2]. Second, whether nasal obstruction is present and the condition inside the nose[1]. Third, considering facial asymmetry, how straight you aim to achieve[4][5].

Whether your nasal deviation originates from where you think and how much straightening is possible cannot be determined from an article alone. Have both the outside and inside of your nose examined, and confirm these points.