The short answers

Two histories: Injury, or the way the nose grewA nose broken years ago heals in the position it was left in, so the deformity is fixed rather than fresh.
Common cause of obstruction: Deviated nasal septumOften combined with turbinate enlargement or weakness of the nasal valve.
Assessment: Internal examination, not photographs aloneAirflow problems cannot be judged from external appearance.
Combined surgery: Septum and shape can be addressed togetherReferred to as septorhinoplasty when both are done in one operation.
Revision rate quoted: Up to 15 per cent after rhinoplastySurgical reference material, quoted for rhinoplasty as a whole. Nothing we found breaks it down by deformity.
Settling time: Often beyond 18 monthsGrafted and scarred tissue holds swelling longer than tissue never operated on.

It is often noticed in a photograph rather than in a mirror. A mirror reverses the image and you see it daily, so the eye adjusts to it. A camera does not.

Faces are naturally asymmetric, so a nose can sit slightly off the midline and still look balanced. What matters is whether the framework is bent and whether the airway is affected.

Injury, or the way the nose grew

A surgeon should ask which of two histories applies, because they are not the same problem. Either the framework grew off centre, or something displaced it and it healed where it was left.

Where there was no injury, the bend is the shape the framework grew into. Nothing applied to the outside changes it, and the septum behind the skin is usually bent too.

The nose broken years ago

A broken nose that was never set, or that was set and then shifted, heals in the position it was left in. Bone knits and bent cartilage stays bent, so what remains is a healed deformity rather than a fracture.

Correction is therefore not the same as setting a fresh break. It means controlled cuts in the nasal bones to reposition them and, in most cases, straightening the septum behind them.

Why the septum is almost always involved

A crooked nose is rarely crooked only on the outside. The septum is the central support of the nose, so when it is bent the external nose follows it.

Correction therefore means working on the septum as well as the external framework. Straightening only what is visible leaves the deforming force in place, and the result tends to drift back as it heals.

Septum and shape can be addressed together. When both are done in one operation it is called a septorhinoplasty, and that is the usual operation for a nose that is bent and blocked.

A plan that addresses only the visible bend is worth a question, because the structure that produced it is still there.

Why the septum makes this a breathing question too

The septum divides the airway in two, so a bend that shows on the outside can narrow one side inside. A deviated septum is a common cause of nasal obstruction.

Airflow cannot be judged from external appearance, so assessment means internal examination rather than photographs alone. A visible bend does not by itself establish that the airway is obstructed.

A randomised trial in The BMJ gave 378 adults with septal deviation and a NOSE score above 30 either septoplasty or a nasal steroid and saline, and favoured surgery. What it measured is set out under breathing.

A bend is not the only thing that blocks a nose. Weakness of the nasal valve and enlarged turbinates can each obstruct, and can coexist with a deviation.

Breathing improvement is typically noticed once swelling subsides. Internal swelling can make breathing feel worse for the first weeks, which is expected.

What straightening actually involves

What straightening involves depends on where the deviation sits, and most cases involve more than one level. A plan naming only one is worth asking about.

The bony vault. Controlled cuts in the nasal bones, called osteotomies, reposition the upper third.
The middle third. Spreader grafts placed alongside the dorsal septum hold the correction in place.
The septum. The bent portion is straightened or removed, leaving an L-shaped strut along the dorsal and caudal margins so that support is preserved.

The framework is most often exposed through an open approach, which adds a short incision across the columella.

Septal cartilage is the first choice where it is intact and sufficient. Where it has already been used or is damaged, graft material has to come from elsewhere, and the trade-offs are set out under revision surgery.

None of these is a result. They describe how support is repositioned and held.

Why perfectly straight is not the promise

Displaced, scarred or missing support behaves less consistently than tissue that has not been disturbed. Plan and result therefore correspond less closely than in a straightforward primary case.

Surgical reference material quotes revision rates of up to 15 per cent after rhinoplasty. That figure is for rhinoplasty as a whole, and a population figure is not a prediction for one nose.

A surgeon who says in advance that the aim is improvement rather than a perfectly straight nose is describing the operation accurately. One who promises symmetry is describing marketing.

Grafted and scarred tissue holds swelling longer than tissue never operated on, so a settled result here is often judged beyond eighteen months rather than at twelve.

Before a straightening operation is booked

A plan is only as good as the person proposing it. Ask what is actually crooked in your nose, the bone or the septum or both, and what the plan does about each. Our doctors answer questions sent through the site.

Questions to ask a surgeon

Take these to a consultation. The consultation checklist is built to be printed and written on, and our doctors will answer questions sent through the site before you travel.

Is my septum bent as well as the outside of my nose, and did you establish that by internal examination rather than from photographs?
How straight do you expect my nose to be, and what happens if it drifts back as it heals?
Will osteotomies, spreader grafts and septal work all be part of the plan, and what supports the middle third afterwards?
Is my breathing being assessed and treated in the same operation, or is this a cosmetic correction only?
Where would graft cartilage come from in my case, and what does that add to the risks and to the recovery?
What is your own revision rate for crooked and post-traumatic noses, and who pays if a second operation is needed after I fly home?

Sources

Every source below was opened and checked. We link to health authorities, peer-reviewed journals and professional bodies, and to nothing else.

RhinoplastyStatPearls, NCBI Bookshelf (National Library of Medicine)Peer-reviewed clinical reference covering anatomy, technique selection and complications.
Saddle nose: causes and treatmentCleveland ClinicPatient-facing explanation of nasal collapse and how it is corrected.
Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trialThe BMJ, via PubMedThe NAIROS trial. Randomised evidence that septoplasty outperforms medical management in adults with obstruction associated with a deviated septum.