Crooked nose: shave or lower the entire bridge? Choose based on how the step deformity appears

Crooked nose correction basically combines shaving the dorsal hump, cutting the nasal bones to adjust width, and reshaping the nasal tip.[1]Recently, a preservation technique that lowers the entire nasal bridge without shaving the hump has become more widespread, and which you choose determines how the remaining step deformity will appear.[2].

What is being done in crooked nose surgery?

The dorsal hump is made up of nasal bone on the upper part and nasal septum and lateral cartilage on the lower part. The standard approach to crooked nose correction involves shaving this hump, cutting the nasal bones to narrow the width, and reshaping the nasal tip as needed.[1]When the nasal bridge is curved, combining the hump-shaving procedure with bilateral nasal bone cuts allows straightening of the curve and improvement of the profile simultaneously.[3].

Why is nasal bone cutting involved?

When you shave the hump, a gap forms between the left and right nasal bones like a roof has been removed. Closing this gap is one of the main purposes of the nasal bone cutting procedure.[1]Nasal bone cutting is also used for other purposes: narrowing wide nasal bones, widening narrow nasal bones, and correcting humps, depressions, or nasal bone curvature.[1].

What is the method without shaving?

The nasal bridge preservation technique is an approach that lowers the nasal bridge without shaving the hump, with its scope and applications summarized in a systematic review.[2]Actual surgical techniques vary, including reports combining the lateral strip of the nasal septum with internal spreading grafts,[4]and reports comparing different techniques by measuring the recoil force of the nasal bridge.[5]There are also reports that combining the preservation technique with nasal septum surgery reduces revision rates and increases satisfaction.[6].

Where do complications appear?

Complications of the shaving method include a gap remaining like a roof has been removed, saddle nose where the nasal bridge collapses, and nasal bridge irregularities.[1]When saddle nose and nasal obstruction occur together, cases have been reported where correction using costal cartilage resolved both issues simultaneously.[7]The more you shave, the more support is lost, so how much to lower is determined together with how much support to preserve.[1].

Which method is suitable?

For noses with large humps and wide nasal bones, the approach of shaving and narrowing the width is more suitable.[1]If you want to preserve the original shape of the nasal bridge or avoid creating irregularities in the nasal bridge, the preservation technique is an option.[2]However, standardization of the preservation technique is still in progress, and which type is suitable for which nose varies across reports.[2].

What to confirm during consultation

During consultation, we examine how much of the hump is bone and where cartilage begins, the width of the nasal bones, and whether the nasal septum is deviated.[1]If you choose the shaving method, confirm whether nasal bone cutting will be performed simultaneously; if you choose the preservation technique, confirm whether nasal septum surgery will be performed at the same time.[6]Confirming with your doctor how much to lower and the amount of support that will remain afterward makes your decision more stable.[1].