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Morisada et al. Plast Aesthet Res 2024;11:35 Plastic and
DOI: 10.20517/2347-9264.2023.119
Aesthetic Research

Perspective Open Access

Structural rhinoplasty for the persistently twisted
nose

Megan V. Morisada, Clinton D. Humphrey, J. David Kriet

Department of Otolaryngology - Head and Neck Surgery, University of Kansas, Kansas City, KS 66160, USA
Correspondence to: Dr. J. David Kriet, Department of Otolaryngology—Head and Neck Surgery, University of Kansas Medical
Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA. E-mail: dkriet@kumc.edu

How to cite this article: Morisada MV, Humphrey CD, Kriet JD. Structural rhinoplasty for the persistently twisted nose. Plast
Aesthet Res 2024;11:35. https://dx.doi.org/10.20517/2347-9264.2023.119

Received: 20 Nov 2023 First Decision: 24 May 2024 Revised: 15 Jul 2024 Accepted: 30 July 2024 Pulished: 8 Aug 2024

Academic Editors: Paolo Boffano, Raffaele Rauso Copy Editor: Yanbin Bai Production Editor: Yanbin Bai

Abstract
Correction of a crooked nose after primary rhinoplasty is a not uncommon and often complex problem encountered
by facial plastic surgeons. Adequate and lasting correction of the deformity requires a thorough assessment of the
anatomy contributing to the deviation, as well as the application of robust techniques to correct the problem at
each subsite, which is reviewed in this article. Finally, risk factors for failure and common pitfalls are discussed.

Keywords: Rhinoplasty, crooked, twisted, nose, structural, deviated

INTRODUCTION
The persistently twisted or crooked nose after primary rhinoplasty is a challenging problem that often
presents to the facial plastic surgery clinic. Etiologies can include prior blunt trauma (e.g., motor vehicle
collision, sports), iatrogenic (e.g., prior nasal surgery), or congenital deformities. These patients often
present with cosmetic as well as functional problems which can be distressing to the patient from both a
physical and psychosocial standpoint, particularly when they have already failed prior surgical repair(s).
Adequate correction requires a thorough analysis and understanding of each aspect of the deviation. This
article details a systematic and level-based approach to achieving this. While a variety of techniques are
available and have been previously described in the literature, we will focus on structural correction of more
severe deformities affecting multiple levels using basic and advanced techniques for the rhinoplasty surgeon.

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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