ArticleAesthetic surgery journal. Open forum2026
Asymmetric Osteotomies in Structural Rhinoplasty: A Pisa Tower-Inspired Approach for Crooked Noses.
Article in Aesthetic surgery journal. Open forum, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background: The Pisa Tower Concept, originally described by Finocchi et al, corrects bony vault deviation through asymmetric osteotomies without dorsal reduction. This study evaluates a structural adaptation in which asymmetric osteotomies are integrated into a structural workflow including dorsal hump management and septal reconstruction. Objectives: The objective of this study was to assess the effectiveness, safety, and satisfaction of Pisa Tower-style osteotomies as an adjunct to structural rhinoplasty for crooked nose. Methods: A retrospective analysis was conducted on 37 patients undergoing structural rhinoplasty for crooked nose deformity. Osteotomies were adapted from the Pisa Tower model: low-to-low or high-to-low lateral osteotomy on the concave side, wedge resection on the convex side, and transverse or oblique osteotomy depending on deviation origin. All patients underwent endoscopic L-strut septoplasty, dorsal hump removal, and tip support with a septal extension graft. Outcomes included pre- and postoperative CT-based R-Webster angles, nasal axis deviation, a 5-point Likert satisfaction scale, and complications, after a mean follow-up of 18 months (range 12-28). Results: Mean nasal axis deviation improved from 7.9° ± 1.9° to 1.2° ± 0.6° ( Conclusions: In this preliminary report, Pisa Tower-style asymmetric osteotomies may represent a promising adjunct to structural rhinoplasty for the correction of bony nasal deviation, extending Finocchi's concept to a structural framework. Level of Evidence 4 Therapeutic: For image description, please refer to the figure legend and surrounding text.
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