In short. The upper bridge, the septum and the tip can each be off centre, and the combination decides what an operation has to address.
Key points
- A deviation of the bony bridge alone, a deviation of the septum alone, and the two together are three different problems with three different plans.
- The commonest finding after an injury is both at once, which is why an operation that addresses only the visible part of the nose can leave the breathing exactly as it was.
A nose that is off centre is off centre in one of three places, or in more than one at once. The upper bridge is bone, the middle and lower parts are cartilage, and the septum is a wall inside the nose that most people have never thought about. Naming which of them is deviated is what decides the plan.
The bony vault, which is the upper bridge
The upper part of the bridge is bone, and it is the part that shows as a tilt when the face is viewed from the front. It is also the part that is most often affected by an injury, because it is rigid and takes the force directly. Straightening it means working on the bone rather than on the cartilage below it.
The cartilaginous part, which can spring back
The middle and lower bridge is cartilage, and unlike bone it can be pushed from side to side. That gives it a property that matters after any correction: a cartilage that has been straightened has a tendency to return toward where it was, which is why a deviation corrected in this part of the nose sometimes drifts back over time.
The septum, which is inside and often forgotten
The septum divides the two sides of the nose and is made of cartilage and bone. It is very often the real cause, both of a blockage and of part of the visible tilt, and it cannot be assessed from outside. A septum that is bent to one side narrows that side of the airway, and it does so whether or not the outside of the nose looks deviated.
Why the combination decides the operation
A deviation of the bony bridge alone, a deviation of the septum alone, and the two together are three different problems with three different plans. The commonest finding after an injury is both at once, which is why an operation that addresses only the visible part of the nose can leave the breathing exactly as it was.
Why the tip is part of the question
The tip can sit off centre on its own, and it is often what decides whether a nose looks straight to the eye. A bridge that has been straightened and a tip that still deviates produces a nose that still reads as crooked. The tip is assessed with the bridge rather than after it, because the plan has to account for both.
What this means before any treatment
The finding is established by examining inside the nose, feeling the bridge along its length and looking at the nose from several angles. Which parts are involved, and whether the airway is affected, decides whether the right plan is a functional one, an appearance one, or a combined one.
Findings that need care rather than a plan
- Difficulty breathing, or bleeding that will not stop with pressure.
- A nose that changed suddenly, or swelling with fever and redness.
- Obstruction that is complete on one side and getting worse.
Those come before any question of shape. What the examination then looks at is set out in how a crooked nose is assessed.
Frequently asked questions
How can I tell whether my deviation is bony or cartilaginous?
Feel along the bridge with a finger. The upper part, from between the eyes down to about the middle, is firm and unyielding, which is bone. The lower part is springier and can be pushed slightly from side to side, which is cartilage. Where the firm part is off centre the deviation is bony, and where the springy part is, it is cartilaginous. It is a rough test and it points in the right direction.
Does it matter which one is deviated?
It does, because the two are corrected in different ways and a plan that addresses one may leave the other untouched. A bony deviation is straightened by working on the bone; a cartilaginous one by reshaping or supporting the cartilage. Where both are involved, which is common, the plan addresses both, and that is a larger undertaking than either alone.
Why does the septum matter if it is inside the nose?
Because the septum is the wall that divides the airway, and it is very often the cause of both the blockage and part of the visible tilt. It can be bent while the outside of the nose looks straight, and it can be straight while the outside is tilted. It is examined directly rather than inferred from the shape.
Risks & Limitations
- Every treatment on this ladder carries risk, and no result can be guaranteed.
- With any operation on the nose: bleeding, infection, asymmetry, altered or reduced sensation, and a change in how the nose feels inside.
- Breathing may improve, stay the same or change after an operation on the nose. It is recorded before treatment so that any change can be judged against a baseline.
- The septum can drift back toward its original position over the first year or two, which is why the corrected position is supported rather than simply moved.
- A dry nose, crusting or a change in the sense of smell can occur and may need ongoing simple care.
- With filler in the nose: an uncommon but serious risk to the blood supply of the skin and the eye, which is why this region is treated differently from the rest of the face.
- Further surgery, including revision, may be needed, and a second operation is more difficult than the first.
When to Seek Care
- Difficulty breathing, or severe pain in or around the nose — seek emergency care immediately.
- Bleeding from the nose that does not stop with firm pressure, or bleeding after an injury.
- Fever with redness, warmth or swelling around the nose — seek care promptly.
- A change in vision, or severe eye pain, after any treatment on the nose — seek emergency care immediately.
- A nose that changed suddenly, obstruction that is complete on one side, or a loss of smell that has appeared.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — rhinoplasty and patient safety guidance
- International Society of Aesthetic Plastic Surgery (ISAPS)
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews in nasal surgery
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.