How reliable is the effect of correcting a hooked nose? Research on recurrence risk

The step deformity of a hooked nose can be effectively reduced with surgery. The effect can be confirmed in before-and-after images[1]. However, "whether the overall line of the nasal bridge becomes beautiful" is a different matter. With preservation techniques (surgical methods that reduce the step while maintaining the nasal foundation), reports show that in many cases the step decreases but the overall line does not change much.[1]Additionally, the biggest issue is recurrence of the step deformity (the step returning after it has been reduced). Comparative data showing that recurrence has decreased with improvements in fixation methods are now emerging[2].

What effects are confirmed by research?

What is clearly confirmed is the effect of "reducing the step." In a review summarizing research on preservation techniques (a compilation of many studies), the improvement of the step deformity was confirmed in before-and-after imaging. On the other hand, reports also indicate that in many cases the overall nasal bridge line does not change much.[1]. In other words, the effect of "reducing the step" and the effect of "straightening the nasal bridge" need to be considered separately. This review also calls for caution, noting that preservation techniques may be overused even for noses with irregular lines.[1].

How reliable is the research?

To be honest, it cannot yet be said to be sufficient. The research that could be referenced this time consisted primarily of systematic reviews (compilations of many studies),[1]studies comparing surgical techniques at a single facility,[2]and individual case reports.[3]High-quality research (randomized controlled trials) directly comparing surgical techniques over long periods was not found. The direction of the effect has been confirmed. However, we are not yet at a stage where we can definitively state "which technique is superior even years later." This is the honest current state.

How much of a problem is step recurrence? Are there ways to prevent it?

Recurrence is the biggest issue with this surgery. However, there is a possibility of reducing it through improvements in fixation methods. In a report of a surgical technique that improved the fixation method of the nasal septum (the bone and cartilage partition in the middle of the nose), the conventional fixation method with 72 cases (72 individuals) and the improved method with 159 cases (159 individuals) were compared. Complications and step recurrence were clearly more frequent (with statistical significance) only in the conventional method group.[2]. How the nasal septum, which serves as the foundation, is fixed is one of the keys to reducing recurrence. If you are concerned about recurrence, it is advisable to ask during your consultation "which fixation method will you use?"

Is there risk of over-reduction?

Yes, there is. Preservation techniques also involve surgery to reduce bone and cartilage. If the nasal dorsum (nasal bridge), particularly the nasal root, is reduced too much, there is a risk of saddle nose (a condition where the nasal bridge becomes depressed) in Asian populations.[3]. If the goal is only to eliminate the step, it may create a different concern: "the nasal bridge is too low." How the reduction width is determined based on what reference point is also something you should confirm during your consultation.

How much can you expect?

There is research backing the reduction of the step. On the other hand, the overall appearance of the line and whether the refined state lasts a long time depend on the design of the surgical technique and whether it is appropriate for that individual. This cannot be guaranteed in advance.[1][2]. The ratio of bone to cartilage, the condition of the line, and skin quality cannot be fully judged from the outside on your own. It is more practical to have a consultation where a doctor examines you, receive explanations about recurrence prevention measures and the basis for the reduction width, and then make your decision.