Many patients have twisted noses but have never experienced any problems such that surgery is required. Indeed some celebrities are recognisable because of their twisted noses and examples include Stephen Fry, Cat Deeley and Daniel Day-Lewis.
The twisted nose is usually due to bony and/or cartilaginous deformities or indeed involving both structures. In some patients, twisting of the nose occurs after a previous operation due to asymmetric scar tissue formation and contraction, particularly affecting the nasal tip. Correction of a twisted nose is one of the most challenging aspects of rhinoplasty surgery. Rather like rebuilding a house, the foundations have to be corrected and only then can any subtle improvements be reliably assured. In some severely traumatised noses, surgical correction may need to be staged to get the optimum result over an 18 to 24 month period.
There is often inadequate good cartilage from the patient’s own nose available for the reconstructive process. Some new bio materials are used to assist the reconstructive process such as the relatively newly introduced biodegradable PDS foil onto which fragments of cartilage can be sutured. The fragments are then placed back onto the nose and healing occurs between the fragments but the biodegradable scaffold disintegrates over a period of time.