In short. The internal exam, the airway, the bony and cartilaginous components and the photographs: what each finding means for the plan and its limits.
Key points
- Cartilage that has been straightened tends to move back toward where it was, which is why a correction in the cartilaginous part of the nose sometimes loses ground over time.
- Surgeons plan for this by supporting the new position rather than only moving the cartilage into it.
- It is one of the reasons a result can be straighter than before without being straight for ever.
The examination has two halves, and they answer different questions. The inside of the nose is examined to establish whether it blocks and what is causing that. The outside is examined to establish what is deviated and how it relates to the rest of the face. The order matters, because the first half can change the plan entirely.
Inside the nose: the septum and the lining
The septum is looked at directly, and the lining and the valves are examined with it. This is where a bent septum that is invisible from outside is found, and where inflammation of the lining is seen. It is also where the cause of a blockage that is not structural becomes apparent, which is why it comes first.
The airway, and how air moves through each side
How much air passes through each side, and where the narrowing sits, is established. A small camera may be used where the question needs a closer look. The finding is a baseline as well as a diagnosis: it is what any change in breathing after treatment is measured against.
The bridge, felt along its length
The upper bridge is bone and the middle and lower parts are cartilage, and they are felt separately because they behave differently. Bone is rigid and takes an injury directly; cartilage is springy and has a tendency to return toward its original position after correction. Which part is deviated decides what the plan has to address.
Why cartilage drifts back, and why that is planned for
Cartilage that has been straightened tends to move back toward where it was, which is why a correction in the cartilaginous part of the nose sometimes loses ground over time. Surgeons plan for this by supporting the new position rather than only moving the cartilage into it. It is one of the reasons a result can be straighter than before without being straight for ever.
The tip, and the nose as a whole
The tip is examined because it can deviate on its own and because it decides much of how straight a nose appears. The nose is then looked at from the front, from both sides and from below, because a deviation that is obvious from one angle can be invisible from another, and a plan has to account for all of them.
Photographs, injuries and the timeline
Standardised photographs from several angles are taken as the record against which a result is judged later. Injuries are asked about specifically, including old ones and ones that were never treated, and the timeline matters: a deviation that has been stable for years is planned differently from one that appeared recently.
What the assessment should rule out first
- Fever with redness, warmth or swelling around the nose.
- A nose that changed suddenly, or after a recent injury.
- Obstruction that is complete on one side, or a loss of smell that has appeared.
Those are medical findings and they come before any plan. Where the assessment finds a stable deviation, what each option changes is set out in the treatment ladder for a crooked nose.
Frequently asked questions
Is the examination uncomfortable?
It is usually quick and only mildly uncomfortable. Looking inside the nose uses a small instrument and sometimes a light, and the surgeon will feel along the bridge to judge which part is firm bone and which is springy cartilage. Where the airway needs closer assessment, a small camera may be used. None of it requires preparation or recovery.
Will I be offered treatment for allergy before surgery?
Often, where the history suggests it. A trial of treatment for allergy, dryness or spray overuse is a sensible first step, because it is reversible and it may resolve the obstruction entirely. Where it does not, the remaining blockage is more likely to be structural and the plan can be made with more confidence.
How soon after an injury can the nose be assessed?
The swelling has to settle before the shape can be judged, which usually takes some weeks. Until then, an assessment describes what is visible rather than what will remain. There is sometimes a short window in which a fresh injury is treated, and outside that window the usual approach is to wait and reassess rather than to plan against a nose that is still changing.
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.