Deviated nasal septum: correcting a crooked nose with plastic surgery

The nasal septum is the internal wall of the nose that divides the two nasal cavities. When the nasal septum is deviated — for example following an accident — the resulting crooked nose can be a source of self-consciousness but can also cause breathing problems. There are several ways to remedy this deformity of the inner wall of the nose. Both septoplasty and rhinoplasty are popular procedures praised for their effectiveness, although they have relatively different goals. Here is what you need to know about the different ways to correct a crooked nose with plastic surgery.

One point to make clear from the outset: a deviated septum is extremely common. ENT learned societies estimate that 70 to 80% of the population has a more or less deviated septum, most often without realising it. In the vast majority of cases this deviation remains minor and completely asymptomatic, and therefore calls for no treatment at all. Only deviations that genuinely affect breathing or facial harmony warrant treatment.

What causes a crooked nose?

The nose is made up of two types of structure. On the one hand, the bony structure in its upper part and, on the other, the cartilaginous structure in its lower part, each with its own implications. Two main causes can be identified to explain a crooked nose:

• A natural curvature, that is, an architectural malformation present at birth or developing during growth, particularly in adolescence;
• Trauma, such as a blow, an accident or an impact during sport.

In both cases, a deviated nasal septum is perceptible to the patient (even if it is not always visible), causing various functional problems and, in some cases, aesthetic self-consciousness. Note that a nose can also become crooked some time after an initial procedure: a nose that is deviated after rhinoplasty is often due to irregular healing or to inadequate cartilage support, and is corrected with a secondary rhinoplasty.

What are the consequences of a deviated nasal septum?

A deviated nasal septum can be the source of various symptoms and thus cause functional problems for a patient. These include in particular:

• Breathing difficulties or discomfort;
• A constant feeling of a blocked nose, especially on one side;
• Frequent headaches;
• A tendency to snore very loudly when falling asleep;
• Repeated nosebleeds;
• Frequent facial pain.

Beyond these immediate signs, a deviated nasal septum often has more insidious repercussions on daily life. A blocked nostril forces you to breathe through the mouth, especially at night: sleep becomes fragmented, which explains the daytime fatigue and lack of restful recovery that are frequently reported. Snoring, and even genuine episodes of apnoea, can also result. By disrupting sinus drainage, the deviation also encourages recurring sinusitis and a feeling of pressure in the face, as well as the headaches mentioned above. It is often these effects on quality of life, more than the aesthetic concern, that lead patients to consider surgery.

When a patient notices several of these symptoms, it is best to arrange a consultation with an ENT physician to determine whether a deviated septum is present and, if so, to consider a corrective procedure. To find out whether you have a deviated nasal septum, the clinical examination is supplemented if needed by a nasal endoscopy or a facial CT scan, which reveal the deviation and measure its impact. Several procedures can then be considered to correct a crooked nose.

Septoplasty to correct a deviated septum

To reshape a crooked nose that causes discomfort or breathing difficulties, septoplasty is the most appropriate surgical procedure. It is an operation aimed at reshaping the deformed parts of the nasal septum through the natural openings, without necessarily changing the appearance of the nose. It is also often combined with turbinoplasty, which involves removing a small part of the inferior turbinates, whose size can sometimes cause nasal obstruction, thereby improving nasal airflow.

The septoplasty procedure in practice

Most often, the septoplasty procedure is performed under general anaesthesia with a hospital stay of 1 to 3 days. In some cases it can also be carried out as a day case, that is, with discharge from hospital the same evening. The procedure amounts to repositioning the nasal septum without any need to alter the external framework of the nose and therefore its appearance. The repositioning of the septum is most often performed via the endonasal route (through an incision inside the nostrils), leaving no external scar.

In the most extreme cases, with a significant deviation, the incision may be made via the external route, at the base of the nose (external septoplasty). After exposing the nasal septum, the surgeon can then reshape it according to the plan agreed with the patient. At the end of the procedure, lubricated dressings (intranasal packing) are placed inside the nostrils, along with a plaster nasal dressing or a splint on the nose.

Recovery

The intranasal packing placed to limit swelling and bleeding is removed between the first and fifth day of recovery, depending on the extent of the procedure. The splint or dressing is removed 7 to 10 days after the operation. In general, recovery after septoplasty causes little discomfort and pain. Swelling and bruising may appear, as with most surgical procedures, but they fade relatively quickly. Watering of the eyes and increased dental sensitivity in the upper jaw may also be noted for a few days. These too subside naturally in a short time. Maintaining the reshaping that has been performed is essential in the first weeks after the procedure. It is therefore vital to avoid impacts or trauma as much as possible and so to refrain from any intense sporting activity for about 3 months. These principles apply to all nose procedures; we set them out in our guide to aftercare and recovery after plastic surgery.

The risks of complications after surgery to correct a crooked nose

As with any surgical procedure, septoplasty is not without risks, although these remain relatively limited. Certain temporary complications may arise, such as a blocked nose, mild nasal pain or even headaches. Slightly more significant complications can occur but are very rare. These may include, for example, a fever in the 24 to 48 hours after the procedure or, in the worst case, whistling on breathing caused by a perforation of the nasal septum. Finally, a slight deformity of the tip of the nose may be observed if the operation is not carried out by an experienced professional.

The results achieved after a nasal procedure

About ten days after the procedure, the nose regains a more or less normal appearance. The benefits in terms of nasal comfort are fully felt after about one month. To assess its effectiveness, the practitioner may carry out a respiratory assessment around 3 weeks after the septoplasty, in particular by means of an endoscopic examination of the nasal cavities. The improvement in breathing will be all the more noticeable if the deviation was particularly significant.

Rhinoplasty combined with septoplasty to correct a crooked nose

When a deviation of the nose is added to a deviation of the nasal septum, patients can choose, in addition to septoplasty, to undergo a rhinoplasty to straighten a crooked nose — that is, a reshaping of the form of the nose to make it more harmonious with the rest of the face. Combined with septoplasty, this is known as rhinoseptoplasty. These two procedures are regularly carried out together, since a deviation of the nose is in the vast majority of cases explained by a deviation of the nasal septum. Rhinoseptoplasty therefore first consists of straightening the nasal septum at the start of the procedure, then reshaping the external surface of the nose to remove its irregularities and adjust its proportions in relation to the other features of the face (chin, forehead and lips in particular). The precise course of this combined procedure is explained in our dedicated article on the surgical correction of the nasal septum by rhinoseptoplasty.

Alongside the functional aspect of septoplasty, rhinoplasty has a purely aesthetic character. It aims to correct a defect that is a source of self-consciousness for the patient, such as a bump or a dip on the nose, a nose that is too wide, too long or too flat, a deviated nose (a « crooked nose »), or a tip that is too drooping or, conversely, too upturned and poorly defined — an area that can be treated in a targeted way, as we explain in relation to tip rhinoplasty. Given its purely aesthetic nature, rhinoplasty is not covered by French national health insurance, unlike septoplasty when the latter is intended to correct a nasal obstruction and all the associated breathing problems.

Nevertheless, the two procedures can be performed at the same time. Only the part aimed at correcting the deviation of the nasal septum is then eligible for insurance coverage. The aesthetic part remains the patient’s responsibility: we detail these arrangements in our feature on the cost of a rhinoplasty and its insurance coverage. In some cases, rhinoseptoplasty can even be combined with a genioplasty (chin surgery) in order to harmonise the proportions even further.

Using aesthetic medicine to correct a crooked nose

To remedy a crooked nose, there are other non-surgical and therefore less invasive techniques that fall under aesthetic medicine. This is notably the case with non-surgical rhinoplasty using hyaluronic acid (or rhinoplasty without surgery), which can correct moderate defects of the nose. It involves injecting hyaluronic acid into specific areas of the nose so that it can reshape the volumes as well as the line of the profile. If you have a bump, for example, the doctor will inject above and below the bump in order to recreate a straight profile. To straighten a crooked nose, the practitioner will in this case introduce the product into the hollowed areas in order to rebalance the contour.

Non-surgical rhinoplasty in practice

The first step for a non-surgical procedure is a preliminary discussion between the patient and the practitioner. During this discussion you can explain your expectations to the doctor in detail. The doctor then carries out a simulation to show you the final result you can expect after the injections. A further appointment is then scheduled directly at the surgeon’s practice, without any need for hospitalisation.

On the day itself, the session begins with disinfection followed by the application of an anaesthetic cream to the nose. The practitioner then carries out the various injections using a fine needle or a micro-cannula. The injections are performed very gently and gradually, in contact with the bone and the cartilage. The product is then distributed evenly by the surgeon’s fingers according to the areas to be reshaped, for a uniform result. No dressing is needed at the end of the procedure. The session generally lasts 15 to 30 minutes depending on the extent of the area to be filled. The result is then visible immediately and lasts 12 to 18 months. Should you notice some bumps, redness or swelling, rest assured that these very mild side effects disappear after a few days.

Advantages and limitations of non-surgical rhinoplasty for correcting a crooked nose

As an aesthetic-medicine procedure, non-surgical rhinoplasty has as its main advantages the fact that it is completely painless and perfectly tolerated by your body. Hyaluronic acid is indeed a substance already secreted by our body and is in this respect entirely biocompatible. The results of non-surgical rhinoplasty are moreover particularly convincing for overcoming the various imperfections and irregularities of the nose.

However, it remains a temporary solution for correcting a crooked nose. As the injected hyaluronic acid is a biodegradable substance, it is eliminated naturally over time and you will need to renew the injections every 12 to 18 months. Non-surgical rhinoplasty is also intended for aesthetic purposes only and cannot correct a deviation of the nasal septum. Functional problems will therefore necessarily require a surgical septoplasty procedure.