Dr. Constantine has deep training in all aspects of cosmetic rhinoplasty. This article focuses on the deviated nose and managing it surgically. Correction of the deviated nose poses a challenge in even the most experienced hands. Frequently, the surgeon is faced with both a functional (airway obstruction) and an aesthetic problem that must be addressed con- jointly. Accurate preoperative analysis and intraoperative diagnosis are integral to good outcomes. Caudal septal deviation is frequently present in patients presenting for rhinoplasty. The authors’ current graduated technique for simplifying the management of the caudally deviated septum both aesthetically and functionally is described. If there is a persistent caudal septal deviation that has not been addressed by standard maneuvers, the caudal portion of the anterior septum is resected at the osseocartilaginous junction with the anterior nasal spine and maxillary crest and then sutured back to the periosteum of the anterior nasal spine with 5-0 polydioxanone. We have found this to be a safe and effective way of addressing the caudally deviated septum in the majority of cases. (Plast. Reconstr. Surg. 134: 379e, 2014.)
Achieving a consistent functional and aesthetic result when performing rhinoplasty demands intimate knowledge and understanding of nasal anatomy and physiology. Correction of the deviated nose is no exception. Accurate preoperative analysis and intraoperative diagnosis are essential to the surgeon’s success. Correction of these deformities poses an array of challenges to the rhinoplasty surgeon because of the dilemma of dealing with both functional and aesthetic problems at the same time. The anatomy of a deviated nose can involve asymmetries of the bony pyramid, a septal abnormality, or asymmetries of the upper and lower lateral cartilages, but usually involves some combination of these problems. This can result in nasal airway obstruction without external deviation, external deviation without nasal airway obstruction, or external deviation with nasal airway obstruction. In addition, facial asymmetries add complexity to the analysis.