A fall, a ball or an elbow can break or bend the nose. Most noses look as they did before once the swelling has gone, but some stay bent to one side or blocked on one side. Here is what to do in the first days, and how a nose that stays crooked can be straightened later.
The first days: swelling hides the shape
In the first days the nose swells, and bruising often spreads under the eyes. Swelling can make a straight nose look crooked or hide a bend that is really there, so the shape cannot be judged yet; it takes about five days to settle enough for the bones to be checked.
Until then, a cold pack wrapped in a towel, held on the nose for up to 15 minutes at a time, and sleeping with your head raised on an extra pillow ease the swelling and pain; paracetamol helps too. Do not try to push the nose straight yourself, and do not pick or blow it. Avoid strenuous exercise for about two weeks and contact sports for at least six weeks.
If the nose bleeds, sit up, lean forward and pinch the soft part of the nose just above the nostrils for up to 15 minutes, breathing through your mouth.
Signs that need help straight away
Some signs cannot wait. Call 112 or go to the nearest emergency department if any of these appear:
- A nosebleed that will not stop.
- Clear, watery fluid running from the nose, which can be a sign of a serious head injury.
- Other signs of a head injury, such as vomiting, collapsing, difficulty speaking or a severe headache.
- Blurred or double vision, or pain in the eye.
- A large or open wound.
One sign is inside the nose and easy to miss: a swelling, often purple, that blocks one or both sides and can be painful. It may be blood collecting under the lining of the septum, the wall of cartilage and bone that divides the nose in two (a septal haematoma). It needs to be seen straight away and drained; left alone, it can become infected and damage the cartilage that holds up the bridge.
An examination after about a week
Have the nose examined if it looks bent once the first swelling has eased, if one side stays blocked, or if the swelling has not begun to go down after three days. An ENT specialist often sees it seven to ten days after the injury, when the shape can be judged from the outside and the inside. For a simple broken nose an X-ray is usually not needed.
If the nasal bones have moved, they can sometimes be eased back into place under anaesthetic, without any cuts; this is called manipulation, or closed reduction. It has to be done before the bones set: within 14 days of the injury according to patient guidance from ENT UK, the British association of ENT surgeons, and within three weeks according to the NHS. It often improves the shape, but it does not always restore it.
Why the septum often bends too
The nose is built in layers: two small nasal bones at the top, cartilage below them, and inside, the septum, which also helps hold up the bridge. A blow strong enough to move the bones often bends or breaks the septum too, and a bent septum can pull the outside of the nose with it and narrow the airway on one side.
That is why a nose that looks straighter can still be blocked on one side; one that is still blocked three weeks after the injury may have a buckled septum. It is also why a nose straightened only on the outside can drift back, pulled by the septum. A 2023 paper on broken noses reports that a later open operation is often needed after manipulation, especially when the septum was badly involved.
Why correction usually waits some months
After the first weeks the bones have set and can no longer simply be eased back. A nose that is still crooked is then usually corrected with an operation some months later, once the swelling has settled. ENT UK’s guidance mentions further surgery twelve months or more after the injury; the same 2023 paper describes the advantages of an open operation after three months or more, when the septum and the bones can be straightened more fully.
Waiting also shows how the nose has really healed, so you can decide calmly whether you want it changed at all. A slight bend that does not bother you may need no treatment.
Straightening the outside and the inside
After an injury, two kinds of surgery are often combined. Septoplasty straightens the septum through the nostrils, with no cuts on the outside; it is aimed at breathing and is not meant to change how the nose looks. Rhinoplasty techniques change the outside: the bones, the cartilage of the bridge and the tip. Done together, the operation is called septorhinoplasty.
In outline, it takes two to five hours under general anaesthetic, through small cuts inside the nose or with an added small cut on the skin between the nostrils. The septum is straightened and moved back to the middle, keeping a firm strip of it to support the nose. The nasal bones are freed with fine, controlled cuts called osteotomies and moved towards the midline, and the cartilage of the bridge is straightened and held, sometimes with small cartilage grafts, usually from the septum. A splint on the outside holds the bones.
Recovery
Bruising around the eyes usually settles within a week. The outer splint and any splints inside the nose are removed one to two weeks after the operation. Plan for about two weeks off work, longer if your work is dusty or physical. Strenuous exercise and contact sports wait at least two weeks, and the nose stays vulnerable to knocks for a couple of months.
Most of the swelling goes within a few weeks, but the nose can take up to three months to settle and breathing to clear; the final shape is judged at about a year.
Risks of the operation
Nosebleeds are common in the first days; rarely, bleeding is heavy enough to need a return to hospital. Infection and a collection of blood under the lining of the septum are rare but need early treatment. Numbness of the nose tip, the upper teeth or the lips can occur and usually passes with time. A hole in the septum and scar bands inside the nose are less common, and the risks of general anaesthesia are explained before surgery.
The crooked nose has risks of its own. Cartilage tends to return towards its old shape, so the nose can drift back a little in the months after surgery, and the septum may not straighten completely or may bend again; ENT UK’s leaflet on septorhinoplasty puts this at about one in ten cases, and says that five to ten people in every hundred need a further operation to adjust the shape of the nose. No face is perfectly symmetrical; the aim is a nose that is clearly straighter, and how close the result comes differs from person to person.
Questions about your own nose, the timing and whether surgery makes sense for you are answered at a consultation, after an examination.