The nose can get deviated leading to a crooked nose due to one of the following reasons.
It could be due to an injury you may have sustained during the developmental period i.e 8 – 16 years. An injury due to a fall or hit on the nose, which leads to a fracture of the nasal bones or septum, is by far the most common cause of deviation. However, the nose can get deviated even without a history of such an injury, and is a result of differential growth of structures in the nose, especially the bones and cartilage.
The nose may become bent or tilted to one side or both. It is often classed as a C shaped deviation or S shaped deviation. Such deviations invariably involve the septum – a structure in the centre of the nose, which runs vertically back and forms the central tent pole of the nasal pyramid. As the nose grows, the other structures, which are attached to it, also get twisted or grow differentially. Hence, when attempting to correct such a deviation it is important to release all such attachments from the central tent pole i.e the septum, straighten the septum and then reattach the other structures to it.

Correction of deviation of the nose should be done after the period of growth of the nose is over, i.e 16 years. Often cosmetic improvement can be combined along with it, such as reduction of a hump of the nose, augmentation of a depressed nose, narrowing of the nose or tip etc. It is important to realise that the twisted cartilage of the nose has a memory like a spring and has a 30% tendency to spring back to some deviation of its original self.

This is a common problem. Mostly genetic, but could also be developmental. Sharpening and narrowing such a nose is a common request.

A broad nose is one which has a wide alar base. If the alar base is wider than the inner angles of the eye, or the whole nose is wider than the width of the eye, it is said to be broad. The bony side walls of the nose should be 80% of the width of an ideal width nose. In a broad nose, it is 90 – 100% of the width of the alar base.

A boxy tip is one which is rounded wide and curved. It often looks like a button on the tip of the nose. This could be due to the wide spayed out cartilages of the tip of the nose, but many times it could be due to thicker skin and fat under the skin of the tip of the nose.

Narrowing such a nose has to be customised as per the requirement. If the bony part is wide, then an osteotomy and infracture ( moving the bony side walls of the nose in) is required. If the alar base is wide, then the alar base can be moved in as well. Narrowing the tip where the cartilages are splayed is best done by various stitches placed in the cartilages. If the tip has thick skin and sub dermal fat, then reducing this is difficult and fraught with risk of damage to the circulation of the skin.

Please read the link on rhinoplasty for more information about the technique.

This could be due to genetic traits, but often it is developmental. The nasal bridge is low. The take off of the nose from the face is low. Ideally it should be at the level of the upper eyelash line, when seen in profile.

Sometimes the nose is depressed due to injury on the bridge of the nose or surgery. If during the surgery too much of the septum is resected, a saddle deformity develops.

Building up the nose can be done by autologous tissue, i.e patients own tissue such as cartilage or bone, or synthetic material such as poly propylene or silicone. Although augmentation of the nose with synthetic material is easy and tempting, it is susceptible to higher risk of infections. There is also a recognised risk of extrusions, thinning of the skin, etc. Autologous cartilage can be harvested from septum, ear or ribs. Bone grafts is harvested from ilium, olecronon, skull or rib. Please discuss with your consultant at Aesthetics medispa for the pros and cons of each. Autologous tissue is not totally free of risks. Cartliage is prone to warping. This is especially true of rib cartilage. Ear cartilage is uneven. Septal cartilage is usually the best, but often not adequate. Bone is susceptible to resorption, displacement and extrusion.

Although there are problems with whichever method used, the results are dramatic and satisfying.