A crooked or deviated nose is one that, seen from outside, does not follow the midline of the face. Seen from the front it leans to one side, or bends in a C or S shape, and it is usually noticed by the patient long before anyone else. The bend is visible on the outside; when the nose looks straight and only the septum inside is bent, the operation is a septoplasty. Many crooked noses are the result of an injury, sometimes a fracture that was never treated, sometimes a childhood fall that was forgotten. Others simply grew that way.
Straightening a crooked nose is one of the more demanding operations in rhinoplasty, because a bent nose is bent in several layers at once. The bones at the top, the cartilage in the middle, the septum inside and the tip can each deviate in their own direction. Correcting only one of them leaves a nose that looks better from some angles and worse from others. Dr. Teker’s approach is to map every layer before surgery and to correct all of them in one operation.
Inside and outside
A deviated septum is the hidden part of most crooked noses. It pulls the cartilage of the bridge with it and blocks one side of the airway. So the operation begins inside, by straightening the septum while keeping a strong central strip for support. The nasal bones are then freed with fine controlled cuts, known as osteotomies, and moved back to the centre. Finally the cartilage of the middle third is straightened and, more importantly, held straight.
Why holding matters
Cartilage has a memory. Simply bending it back is not enough, because it slowly returns towards its old shape over the months after surgery. Dr. Teker uses spreader grafts, thin strips of the patient’s own septal cartilage placed along the bridge, together with sutures, to lock the middle of the nose in its new position. Where a slight asymmetry remains at the end, small camouflage grafts can be used to reduce it.
Breathing as well as shape
Because the septum is straightened and the valves are supported, breathing on the blocked side usually improves along with the shape.
Straightening and refining together
If you wish, the shape can be refined in the same operation: lowering a hump, narrowing the bridge, defining the tip. All of this is planned on standardised photographs at the consultation and done in the same operation, with one recovery.