A Novel Approach to Crooked Nose in Rhinoplasty: Asymmetric Level Osteotomy Combined With Unilateral Spreader Graft

The crooked nose is certainly among the most difficult to treat deformities for rhinoplasty surgeons. This deformity is a complex problem because each structural nasal component can be effected and they may be asymmetric bilaterally. Despite the use of sophisticated techniques and an additional effort, unfortunately the long-term aesthetic results may not be perfect with some minor flaws. Here in this study, the authors introduce a new technique that is used to correct crooked nose deformity. Sixteen consecutive patients who underwent open approach rhinoplasty by the same senior author between January 2015 and January 2018 with the diagnosis of C-shaped, reverse C-shaped, and I-shaped crooked nose deformity were included. The authors performed low-to-low lateral osteotomy with transverse root osteotomy to concave side (wider side) and low-to-high osteotomy to convex side (narrower side) combined with a unilateral spreader graft to concave side. Frontal images were taken preoperatively and 6 months postoperatively to use for further assessments. The authors compared the preoperative deviation angle values at rhinion (RDA) and at nasal tip (tip deviation angle) with postoperative values. In the study group, RDA value showed significant decrease after surgery; the preoperative RDA value was 6.2° (1.66°-16.39°) and it was calculated as 2.44° (0.7°-5.77°) with P < 0.001 postoperatively. The changes at tip deviation angle were also significant (P < 0.001) and tip deviation was successfully decreased from a value of 5.08° (2.8°-10.62°) to 2.13° (0.5°-6.6°) postoperatively. In conclusion, this study offers a new and effective technique to correct crooked nose deformity that can be used safely with satisfying aesthetic results.