How Do You Fix The S-Shaped Nasal Deformity?

Q: Dr. Eppley,I have been considering a rhinoplasty to straighten the bridge of my nose, smooth it, and possibly narrow it (it is a little wide).  It is difficult to see from some of the photos but my nose goes a little to the right side of my face and has a slight “S” shape.  In one of the photos the “S” shape of my nose is exaggerated from shadow and theuse of a poor camera. I am also considering slightly reducing some of the projection on my chin.

A: The S-shaped nasal deformity is one of the most challenging of all rhinoplasties because the entire nasal structures down through the septum is crooked. In looking at your pictures you have exactly that issue with right nasal bone outward deviation, left nasal bone inward deviation, complete left middle vault collapse with right-sided septal deviation and a wide broad tip. The challenge is to do a rhinoplasty in which the nose is perfectly straight afterword. This requires an open septorhinoplasty with correction of the septal deviation, reduction of inferior turbinates (I suspect you may also have some breathing problems), large septal graft harvest, nasal osteotomies, reconstruction of the middle vault with spreader grafts, nostril narrowing with a columellar strut graft nasal dorsal augmentation with septal cartilage. I have attached some computer imaging to show what the goal of that effort would be. A small amount of chin reduction was done as well, perhaps a 5mm bone reduction.

Dr. Barry Eppley

Indianapolis, Indiana