The above picture is a Before and After Image of a Crooked Nose and after Rhinoplasty. You can click here to see more Before and After Rhinoplasty Images
The Crooked nose and Asymmetric Bridge and the true straightening of this condition is one of the most challenging subjects | cases for the Rhinoplasty surgeon. Over time, the tissue including the skin, cartilage, bone etc takes on some permanence. This "memory" is what makes straightening the nose difficult. Some say that skin has memory as well. Some surgeons believe that the skin memory makes it harder to change the crooked nose. The nose above required us to release all the structures between the upper laterals, lower laterals, and the septum. Full release allows the structures to take on the new memory. It would be helpful to reference this link to Learn more about the Rhinoplasty Procedure. This will help you in the understanding of this subject. But we will try to include all necessary information for you to understand using this page only.
The picture below shows the lower lateral cartilages in blue. They will need to be released from the upper lateral cartilages in the following picture.
The green denotes the upper laterals. They are actually tucked under the lower laterals in blue from the previous picture. The release allows these structures to take on a new position and new memory. Sometimes adjusting these structures will be necessary to allow them to take on a new shape as well.
Septoplasty: This is the procedure where the septum is harvested and work to make this structure straight plays the most important role in the crooked Rhinoplasty. The part that is usually harvested is outlined in dashed green below. There are many ways to make the septum straight: 1. You can take the whole septum out and the replace it in a new orientation; 2. You can make 50% cuts to weaken it to allow it to transform to the straight appearance; 3. The whole septum can be fractured toward the center; 4. You can place grafts on the side that is pushed in to camouflage the deviation or crooked part of the nose; 5. You can sew the septum to the upper laterals and bones in such a way as to make it go straight. more to come...
Tip Straightening: This occurs after the septoplasty and making the septum straight. As most rhinoplasty surgeons say as the septum goes so does the whole nose. Making the septum straight is the start of making the whole nose straight. After this the tip and the way that each lower lateral cartilage relates to each other is important. Releasing the lower lateral cartilages from the structueres that it is attached to is the start of making the tip straight. The restructuring them together helps make them more straight. Grafting with straight cartilage helps to reorient the lower lateral cartilages and allows them to take on a new memory. Sometimes there are parts of the lower lateral cartilages that need to be weakened and then strengthened again to make them straight. If the tip tends to go to one side or the other, you can shorten some of the legs of either the lateral, middle, or medial legs or cruses to allow them to position the tip in the center position.
Camouflage techniques: After all of these other steps, sometimes there are inherent structural differences that will make the nose still not straight or looking the way you want. This is where camouflage techniques can come into play. Crushed, weakened or other pieces of cartilage can be used to fill or contour certain areas of the nose to make the final structure look the best.