FPS Facial Plastic Surgery · 2016

Rhinoplasty: The Asymmetric Crooked Nose-An Overview

Kosins AM, Daniel RK, Nguyen DP.

What this paper says

The authors argue that a crooked nose can be made straighter but rarely perfect, because the nose is asymmetric on an already asymmetric face, and they set out the analysis and techniques involved.

Overview

This overview addresses the crooked nose, which the authors call one of the hardest problems in rhinoplasty. They give three reasons for that difficulty and then cover analysis, preoperative planning, and the surgical techniques available. It is an expert review article rather than a patient series.

Sections of note

Reason one: patients see the obvious deviation but not the differences between the right and left sides, and surgeons often underestimate that every component of the nose is asymmetric.
Reason two: these deformities can be improved but rarely made flawless.
The authors describe counseling patients with comparative words only, better, straighter, cuter, and avoiding absolute words such as perfect or straight.
Reason three: correction demands a wide range of advanced techniques, some with a minimal margin of error.
The article covers analysis, preoperative planning, and technique selection.
The abstract reports no patient numbers, follow-up, or success rates.

What it means for a patient

A realistic expectation for a crooked nose is improvement, not symmetry.
The face underneath is usually asymmetric too, which limits how straight the nose can be made to look.
This is expert opinion with no outcome data, so it does not say how much improvement is typical.
The consultation language described here is a useful signal of a surgeon setting honest expectations.

Why this paper matters

Crooked nose correction generates a high share of revision requests, largely because expectations and anatomy are mismatched at the outset. Framing the goal as improvement changes how success is judged. The paper does not quantify how much straightening current techniques actually achieve.

Terms

Crooked nose: A nose that deviates from the midline of the face.
Ipsilateral: On the same side.
Contralateral: On the opposite side.
Preoperative planning: Deciding before surgery which structures will be changed and how.
Revision: A second operation to correct an earlier result.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“There are three reasons why the asymmetric crooked nose is one of the greatest challenges in rhinoplasty surgery. First, the complexity of the problem is not appreciated by the patient nor understood by the surgeon. Patients often see the obvious deviation of the nose, but not the distinct differences between the…”

Excerpt; the full abstract is on PubMed.