Crooked nose: The asymmetric face

Evaluation of Facial Asymmetry in Patients with Crooked Nose

BACKGROUND

This study aims to explore the correlation between facial asymmetry and a crooked nose using objective methodologies.

METHODS

The cohort of 57 patients who underwent septorhinoplasty surgery for aesthetic reasons between 2019 and 2022. Patients were categorized based on the type of nasal axis deviation. The analysis involved reviewing patients' photographs and cone beam computed tomography images. We identified various anatomical landmarks and compared measurements across the groups.

RESULTS

Among the study population, 21 (36.8%) exhibited Type-I (linear) and 15 (26.3%) demonstrated Type-C nasal axis deviation, while no deviation was detected in 21 (36.8%) patients. Upon evaluating the upper face area, significant differences were found in the glabella-lateral orbit (G-LO) and rhinion-lateral orbit (Rh-LO) parameters (p = 0.002 and p < 0.001, respectively). A statistically significant difference was discovered in all three parameters between the three groups in the middle face area [glabella-zygion (G-Zy) p = 0.04, rhinion-zygion (Rh-Zy) P < 0.001, anterior nasal spine-zygion (ANS-Zy) p < 0.001)]. Further, a statistically significant difference was noted in the soft tissue parameters gonion (Go) and LO (p = 0.008 and P = 0.005, respectively).

CONCLUSION

Patients with crooked noses, in particular, exhibit asymmetries in the upper and middle faces. The glabella in the upper face and the anterior nasal spine in the middle face are stable points, and the fact that the parameters derived from these two reference points are significant, when considered in conjunction with other significant parameters, strongly supports the aforementioned statement.

LEVEL OF EVIDENCE III

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Prevalence of Facial Asymmetry and Correction Methods for Rhinoplasty in Individuals with Deviated Nose: A Brief Review

Background:

Surgeons frequently perform rhinoplasty on individuals who have facial asymmetry. Patients’ discontent following rhinoplasty has been linked to facial asymmetry. On the other hand, correction of a deviated nose is a tough procedure, and it is not the same as septal deviation correction. Surgeons, who often perform rhinoplasty for deviated nose in people with asymmetrical faces, focus primarily on correcting nasal defects and overlook such facial asymmetry.

Aim:

We aimed to summarize and review the prevalence of facial asymmetry in patients subjected for rhinoplasty for deviated nose correction.

Methods:

A systematic search was conducted covering PubMed, Scopus, ISI, and Google Scholar using related key words and MeSH (Medical Subject Headings) terms from 2000 until November 2021 for English published articles.

Results:

The majority of subjects had more facial asymmetry such as chin deviation, nasal deviation, and face breadth. Facial asymmetry is typically found in patients undergoing rhinoplasty for a deviated nose, and its presence frequently results in the failure to achieve a straight-looking nose.

Conclusion:

Patients considering rhinoplasty frequently have facial asymmetries, and careful attention should be devoted to these elements in both surgical planning and patient counseling. In order to create facial harmony and apparent symmetry after rhinoplasty, it is critical to center the nose on the midglabellar to mid–bow Cupid’s line.

The Impact of Facial Asymmetry on the Surgical Outcome of Crooked Nose: A Case Control Study

BACKGROUND

Facial asymmetry is considered a reason for patient dissatisfaction with the outcome of rhinoplasty.

OBJECTIVES

The aim of this study was to evaluate the impact of facial asymmetry on patient postoperative satisfaction with crooked nose and to investigate the relationship between visual perception of asymmetry and anthropometric measurements.

METHODS

In this retrospective study, 61 rhinoplasty patients with crooked noses were assessed. Utilizing frontal view photos, pre- and postoperative nasal deviation angles were calculated. The patients were divided into 2 groups based on the visual presence of facial asymmetry. Moreover, anthropometric characteristics of the face were evaluated utilizing facial soft tissue landmarks. Patient satisfaction with surgery outcomes, including both aesthetic and functional aspects, was assessed employing the Persian version of the Standardized Cosmesis and Health Nasal Outcomes Survey.

RESULTS

Based on the observations, 19 (30.2%) and 44 (69.8%) patients had I-type and C-type noses, respectively. In both groups, the deviation angle decreased significantly postoperatively (P < 0.001). Regarding the subjective evaluation of facial asymmetry, 22 (34.9%) and 41 (65.1%) cases had symmetric and asymmetric faces, respectively. Anthropometric measurements were also consistent with visual assessments of asymmetry. Satisfaction scores were significantly higher after surgery in all patients; however, there was no significant difference in the mean aesthetic improvement between symmetric (15.83 ± 2.68) and asymmetric faces (15.23 ± 4.46) (P = 0.531). The power of study was 97.8%.

CONCLUSIONS

Rhinoplasty in patients with deviated noses and asymmetric faces may have comparable results with symmetric ones.

LEVEL OF EVIDENCE: 4