Deviated noses may be harder to correct than first thought

(Reuters Health) - People who have crooked, or “deviated,” noses are more likely to have a face whose two sides don’t quite match up either, suggests a new study from South Korea.

More than half of the people with deviated noses that the researchers examined had facial asymmetry, compared to about a third of people without deviated noses.

“Many patients who think they have deviated noses actually have combined facial asymmetry,” said Dr. Yong Ju Jang, who is the study’s senior author from the University of Ulsan College of Medicine in Seoul.

“This means that deviated nose is not a simple nose problem in many cases, but is complex issue related with facial skeleton abnormality,” he said in an email to Reuters Health.

Jang and his colleague Dr. Jong Sook Yi write May 7 in JAMA Facial Plastic Surgery that rhinoplasty has become one of the most common facial plastic surgeries.

In their practice, the researchers say many people with deviated noses don’t realize they have facial asymmetry. Often, those people end up unhappy with their rhinoplasty results.

If doctors and patients don’t pay proper attention to facial asymmetry, Jang said, “they often end up with dissatisfaction because of the difficulty in making the nose look straight in patients with facial asymmetry.”

Past studies suggested people with deviated noses are more likely to have facial asymmetry and more severely asymmetrical features.

For the new study, the researchers looked at old pictures of 152 people who underwent surgery for deviated noses between January 2008 and December 2012. They compared those to pictures of 60 people who had surgery to correct internal nose deformities.

Overall, 84 of the 152 people with deviated noses had facial asymmetry, compared to 19 of the 60 people in the comparison group.

Among those with deviated noses, their asymmetric facial features varied, but at least half the patients had asymmetries in the lower third of the face, such as a crooked chin.

The researchers note that deviant noses tended to curve toward the smaller side of asymmetrical faces. That may be because the nose is formed along with the rest of the face during embryonic development and may curve toward the slower-growing side.

The comparison group, with deviated septums inside the nose but no visible signs of external nose deviation, may not be representative of people without any abnormalities, the authors acknowledge.

But finding people with perfectly straight noses is “almost impossible,” they add.

Jang advises people undergoing surgery for deviated noses to examine their face carefully to determine whether they have underlying facial asymmetry.

“The next step will be seeking the best solution for harmonious correction of deviated nose,” he said.


JAMA Facial Plast Surg 2015.