Where should I get deviated nose surgery? How to identify a doctor who examines the cause of the deviation

The starting point for choosing where to get deviated nose surgery is selecting a facility that can diagnose the cause of the deviation by categorizing it into bone, nasal septum, and cartilage. Deviated nose correction involves a combination of five elements: bone cutting, nasal septum (the partition inside the nose) correction, correction of the upper lateral cartilage, correction of the nasal tip and columella, and treatment of the internal nasal folds—which elements are needed varies from person to person[1]. A review article notes that determining the pattern of nasal septum deviation before surgery is important for reducing complications and the need for revision surgery[2].

What should you look at first when choosing a clinic for deviated nose surgery?

The first thing to check is whether the counseling explains "why it is deviated." Textbooks list taking a history of injury (age at injury, how the injury occurred, facial features before injury) as part of the preoperative assessment for deviated nose[1]. Chronic sinusitis, allergic rhinitis, and history of prior nasal septum or nasal surgery are also items to confirm before surgery[1].

The pattern of deviation is also worth asking about. A review summarizing 15 studies that classified nasal septum deviation patterns states that most deviations can be categorized into C-shaped, reverse C-shaped, S-shaped, and reverse S-shaped types, and that distinguishing C-shaped from S-shaped patterns at the surgical planning stage is key to determining whether the surgery will be difficult[2].

Open approach or closed approach—which would be recommended?

For severely deviated noses, many facilities choose the open approach (a method in which the skin of the columella is cut to open the entire structure), and one indicator is whether they can explain the reason. The open approach is often necessary for severe nasal septum deviation, deformity on the nasal tip side, and prominent deviated nose, according to clinical guidance[3]. The same guidance also states that loss of nasal tip support is one of the common failures in nasal septum rhinoplasty[3].

In a prospective study comparing the open and closed approaches in 15 patients each, aesthetic satisfaction was achieved in 12 of 15 patients with the open approach and 9 of 15 patients with the closed approach[4]. Although this is a small study and the magnitude of the difference cannot be definitively established, you can verify whether there is an explanation that "the method is changed depending on the degree of deviation"[4].

Can the difference in bone-cutting methods be explained to you?

If bone deviation is the main issue, it's reassuring to ask about the bone-cutting method. In a study comparing traditional bone cutting with a hybrid method using asymmetric letdown (where the cutting method differs on the left and right to lower the nasal bridge) for deviated nose correction, both methods significantly improved nasal axis deviation, and nasal obstruction assessment (NOSE) at 12 months was also evaluated[5].

Which method is suitable for you depends on the pattern of deviation and whether bone or cartilage is the primary issue. That's why choosing a doctor who can articulate not just the surgical technique name, but "whether your nose needs correction starting from bone or the nasal septum" makes it easier to discuss postoperative deviation as well.

Do they honestly discuss the possibility of revision surgery or dissatisfaction?

Nasal surgery is noted in textbooks as being more likely to result in patient dissatisfaction compared to other cosmetic surgeries[6], and published meta-analyses indicate that it ranks low in satisfaction among cosmetic procedures[7]. Therefore, facilities that discuss "what to do if dissatisfaction arises" from the beginning are more trustworthy.

In a survey of 183 people using the FACE-Q questionnaire, those who underwent revision surgery had lower satisfaction than those undergoing initial surgery, and the most common reason for revision was dissatisfaction with the nasal tip[8]. This survey recommends having two consultations before surgery to confirm expectations and hopes[8].

It's also helpful to know the terminology. Textbooks distinguish between secondary surgery (revision nasal surgery performed by a different surgeon) and revision surgery (revision surgery performed by the same surgeon on their own patient)[9]. When asking "what will be done if revision becomes necessary," framing the question with this distinction in mind will elicit more specific answers.

How detailed is the explanation of postoperative care?

The specificity of postoperative instructions is also a way to distinguish between facilities. In a study of 243 patients who underwent nasal septum surgery, internal adhesion (mucous membranes sticking together) occurred in 26.75% overall; in patients who had a silicone splint placed in the nasal septum, it occurred in 13.1%, and in those without a splint, 46.9%[10].

A review summarizing complications from 36 studies on nasal surgery organized the incidence rates of bleeding, infection, tissue necrosis, and other complications, positioning it as material for providing accurate preoperative information[11]. Rather than focusing on the precise numbers, see whether swelling, bruising, nasal obstruction, and the duration of splinting can be explained to you in straightforward language.

Three things to confirm about your nose during examination

Finally, here are three things worth asking about during the consultation. First is whether the main location of deviation is bone, nasal septum, or cartilage[1]. Some research documents the deformity separately for the upper two-thirds and lower one-third of the nose, selecting techniques for each region[12]. Second is whether you have nasal obstruction, and if so, whether procedures on the nasal septum or internal nasal folds will be performed together[1]. Third is how the deviation will be addressed if it remains more prominent than expected after surgery[8].

Deviated nose surgery design varies depending on injury history, nasal septum shape, and skin thickness. Therefore, the appropriate method for you cannot be determined from an article alone. During consultation, have the pattern and cause of deviation, nasal patency, and prior surgical history confirmed, and work together to clarify which elements need correction and in what order.