Preservation Rhinoplasty and the Crooked Nose

East C.

PubMed 33220837 Publisher (DOI)

What this paper says

A short review arguing that crooked noses are often unsuitable for pure preservation technique and usually require a hybrid of preservation and structural rhinoplasty.

Overview

Preservation rhinoplasty keeps the existing nasal framework and repositions it, which works best when that framework is symmetric. The author states that in a deviated nose many elements are not symmetric, so preserving them preserves the deviation. The article addresses how to approach these cases.

Sections of note

Review article; the abstract reports no patient numbers, no outcomes and no follow up.
Deviated noses are described as the situation where hybridization between preservation and structural rhinoplasty is required.
Careful preoperative evaluation of both soft tissue and bony anatomy is stated as very important.
Asymmetry present from birth or following injury may involve more than the nasal pyramid itself.
Full exposure of the nasal pyramid is said to allow visualization and appropriate osteotomy or rhinosculpture.

What it means for a patient

A nose that bends to one side may not be a candidate for the preservation approach on its own.
Underlying facial asymmetry beyond the nose can limit how straight the result can be made.
This is expert opinion. No data on outcomes in crooked noses is reported.

Why this paper matters

Patient selection is the recurring limitation in preservation rhinoplasty, and the crooked nose is the clearest example. This article states where the technique stops working alone. Which combination of preservation and structural methods gives the straightest result has not been tested.

Terms

Preservation rhinoplasty: surgery that keeps and repositions the existing framework rather than removing and rebuilding it.
Structural rhinoplasty: surgery that removes and rebuilds the framework using grafts and sutures.
Crooked or deviated nose: a nose that bends to one side rather than running straight.
Nasal pyramid: the bone and cartilage framework forming the shape of the nose.
Osteotomy: a controlled cut in bone to reposition it.
Rhinosculpture: reshaping the bone surface with powered instruments rather than cutting through it.

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

From the abstract

“Crooked or deviated noses pose a specific challenge as many of the elements in a deviated nose are not symmetric and therefore not ideal for preservation techniques. Deviated noses are often where a hybridization between preservation and structural rhinoplasty is required. Careful preoperative evaluation of the soft…”

Excerpt; the full abstract is on PubMed.