Crooked nose tip refers to a nasal tip that is off center and leaning to one side or another when compare to the nasal dorsum alignment. A crooked nose tip deformity is easily identifiable as it is located on the center of the face and creates disharmony when compared to the rest of the nose. A crooked nose tip is typically not caused by trauma but rather by embryological development and cannot be repaired in the same fashion as a crooked nasal dorsum deformity. This is because the nasal tip is all cartilaginous and unlike the nasal dorsum which contains bony structural elements, it is not vulnerable to breakage. A final cause of crooked nasal tip is a poorly performed open rhinoplasty whereby the surgeon failed to position the nasal tip in a central location. Whereas a crooked nasal dorsum can be corrected with closed rhinoplasty or closed reduction procedure, the crooked nose tip requires an open rhinoplasty.
This is because only an open rhinoplasty allows access to the nasal tip structures so that they can be modified. The nasal tip is created by two lower lateral cartilages that coalesce together to form what we see as the nasal tip. These cartilages are malleable and cannot be broken back into position like the bony nasal dorsum but rather require manipulation and sutures to keep the cartilage in their new position. Sometimes a columellar cartilage graft is added such as a columellar floating graft or a septal extension graft which is intended to create reinforcement of the nasal tip structures. The addition of cartilage grafts is intended to firm up the nasal tip complex so that it is less malleable and more apt to keep its central alignment. Finally, the crooked nose tip requires specific maneuvers such as interdomal stitches or intradomal stitches which will tighten and refine the nasal tip shape in addition to realigning it. When undergoing an open rhinoplasty, not only will the tip be realigned in a central position but also improve is shape and even position along the central axis. If you feel that you have a crooked nose tip, we encourage you to a make a consultation with our nasal specialist so that he can show you the changes that you can expect.