Nasal Deformities

Monica O. Patadia, MD

The nose is a central and prominent structure of the face. A deformity (abnormality in the appearance) of the nose can significantly change ones facial appearance or result in nasal complaints. Nasal deformity can be categorized as “cosmetic” or “functional.” Cosmetic deformity of the nose results in a less desirable appearance of the nose. A functional deformity of the nose may result in frustrating nasal blockage, noisy breathing or snoring, decreased smell or taste, nose bleeds and/or recurrent sinusitis.

A cosmetic or functional nasal deformity may occur secondary to a crooked septum (the wall in the middle of the nose, that is composed of both cartilage and bone, and divides it between left and right sides), an asymmetric nasal bone, scar tissue, collapse or weakening of nasal structures, or a specific portion of the nose being disproportionate to the remainder of the nose and face. So what causes cosmetic or functional nasal deformity? There are multiple reasons, and often, many of the causes result in both cosmetic and functional problems. The most common causes are listed below.

Congenital (present at birth) deformity – a baby born with a cleft lip, cleft palate, nasal mass or other anomaly (problem) may have structural weakness or asymmetry of the nose. Congenital nasal deformities may require multiple staged surgeries to achieve the final desired result.

Nasal trauma – Injury to the nose can result in a septal hematoma (a collection of blood between the lining of the nose and the nasal septum), septal fracture and deviation (pushed over to one side or the other), or nasal bone fracture. A septal hematoma may result in a saddle nose deformity (a condition where the nose is weakened and hence “saddled” in the middle of the nose). A fracture can result in shifting of nasal structures leading to nasal obstruction and cosmetic changes. If the patient has nasal deformity due to a trauma, they should see their Otolaryngologist within 7-10 days to possibly correct the deformity before it heals.

Prior nasal surgery
– Patients who have undergone previous nasal surgery may experience weakening or collapse in their support structures.

Nasal mass – an external or internal nasal mass can change the shape or alter the function of the nose. These masses may be cancerous or noncancerous.

Age related changes - As patients age, they may experience weakening or collapse of nasal structures.

Medical conditions – Certain nasal and systemic (affecting the entire body) medical conditions may cause structural changes of the nose. Common conditions affecting nasal appearance and function include: Sarcoidosis, Wegner’s Disease, Relapsing Polychondritis and other connective tissue disorders. Allergic Fungal Sinusitis can also affect nasal appearance.

Patient’s perception
- Some patients do not like the appearance of their nose or are self-conscious about their nose. Although this is not a true nasal deformity, it may be very bothersome to the patient. For example, patients may dislike the large size of their nose, the roundness or "pointiness" of their nasal tip, or the large hump on their nose

what to expect at the otolaryngology office
Your Otolaryngologist (ENT) will perform a complete nasal exam and head and neck exam. He or she will check for structural collapse of the nose and a crooked septum. He or she will address your concern about breathing and cosmetic nasal deformity. An Otolaryngologist has at least 5 years of surgical training in operating on the nose, face and neck. For this reasons, an Otolaryngologist is well trained to handle functional and cosmetic deformities of the nose.

A “Rhinoplasty,” also known as “nasal reshaping,” or a “nose job” is a surgery that can help change the appearance of the nose. This can be done to improve the cosmetic appearance of the nose or to help the functional ability of the nose. Depending on the exact deformity, your ENT surgeon may need to get tissue or cartilage from other sites of the body, including the ear or rib to fix the nose. If the surgery is to improve nasal breathing, this surgery may indeed by covered by insurance. If the surgery is only for cosmetic reasons, it may not be. Please see the Rhinoplasty Patient Education topic for more information.

A “Septoplasty” is a surgery used to straighten the crooked cartilage and bone on the inside of the nose. This surgery helps correct the inside of the nose but does not change the appearance of the outside of the nose. Please see the Septal and Turbinate Surgery Patient Education topic for more information.

A “closed reduction” is a procedure either done in the office or in the operating room to re-straighten the nose after it becomes crooked due to nasal trauma. These procedures need to be done in a timely fashion after the trauma.

Revised 02/17/2015
©American Rhinologic Society