Crooked nose after rhinoplasty is an infrequent complication that occurs if the nasal bones are compressed to one side or the other during the healing phase.
During rhinoplasty surgery, the nasal bones are voluntarily fractured to allow for improvement in nasal dorsum alignment as well as the removal of any nasal hump. Once the nasal bones are broken to be repositioned, a one month delay is required before the nasal bones are fused.
If any forces are placed on the nasal bones during this time, the nasal bones may shift or become deviated. As a result, crooked nose after rhinoplasty may be observed if compression of the nasal bones occurs prior to the fusion of the nasal bones in their new, preferred position. Several measures are taken to avoid crooked nose after rhinoplasty.
The first is to ensure that accurate alignment is achieved during surgery. At the completion of the rhinoplasty surgery, an external nasal splint is used to stabilize the nasal bones in their centrally aligned position. You might wonder why the bones are not fixed more securely.
The answer follows the fact that the bones are too thin on the average less than 1 to 2 mm and will not accommodate plates and screws. Instead, rhinoplasty surgeons have to rely on the ability of an external splint to keep the bones in place while they heal.
The fusion of the nasal bones occurs over the first four to six weeks and limited by the time it takes for bone healing to bridge between the nasal bones. Postoperatively, the external splint is kept in place for one week around the clock.
In the second week, the splint is worn only at nights to avoid inadvertent compression by a pillow or forearm when asleep.
Finally, the patients are asked to avoid any physical activity in an attempt to avoid any re-injury to the nose resulting in the crooked nose after rhinoplasty.
Please review this 14-year-old female who had a closed rhinoplasty to correct her crooked nose.