Nasal Deformities

Monica O. Patadia, MD

The nose is a central and prominent structure of the face. A deformity of the nose can significantly alter 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 midline structure of the nose that is composed of both cartilage and bone), an asymmetric nasal bone, scar tissue, collapse or weakening of nasal structures, or a specific portion of the nose (aka subunit) being disproportionate to the remainder of the nose and face. So what causes cosmetic or functional nasal deformity? There are multiple etiologies, 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 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, 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.

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.

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

Medical conditions – Certain nasal and systemic (affect 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
- The most common sites of cosmetic concern include the tip of the nose, the nasal bone, the nasal alae (the lateral surface of the external nose that flares) and the overall asymmetry of the nose. For example, patients may dislike their bulbous, pointy or narrowed tip. The nasal bone may be perceived as too wide, too narrow or have a large bump (see photo below). The alae may notch or flare or the patient may dislike the overall appearance of the nose. Ethnic diversity, patient preference, cultural media and current trends in beauty all influence a patient’s perception of his/her nose.

Your Otolaryngologist will perform a directed nasal exam and facial analysis to identify structural and cosmetic concerns. Nasal analysis and surgery is complex given its 3 dimensional structure. An Otolaryngologist (ENT) has at least 5 years of surgical training where they have solely operated on the nose, face and neck. Some Otolaryngologists have additional training in facial plastic surgery. For these reasons, an Otolaryngologist is well trained to handle cosmetic and functional nasal deformities you face.

Often times, a deviated nasal septum or swollen inferior turbinates (spongy structures consisting of bone and tissue inside the nose) are the primary problem. These findings can be improved with nasal steroid sprays, a septoplasty (a surgery to remove and/or straighten the deviated cartilage), or inferior turbinate reduction. The only way to permanently relieve further structural or cosmetic nasal deformity is surgery, a.k.a. “rhinoplasty” or “nose job.”

A Rhinoplasty is an “elective” procedure, meaning it is an optional surgery done for either medical or cosmetic reasons. Depending on the severity of the nasal deformity, your surgeon may need to obtain tissue or cartilage from other sites of your body, including the ear or rib to reconstruct the nose. Please see the Rhinoplasty topic for more details.

Revised 9/2011
©American Rhinologic Society