Surgical Correction of the Crooked Nose: A Procedure Proposal.

A crooked nose, resulting from the collapse of cartilaginous and/or bony support, often presents with depression of the nasal tip and middle third. This condition is frequently associated with septal deformities that impair breathing and cause damage to the upper lateral cartilages and bony framework. Traditional surgical techniques typically involve septal correction and the use of cartilage grafts to restore structure and projection, though such methods carry a risk of fibrosis and recurrent deformity. We present an alternative surgical approach that reconstructs the nasal pyramid without the use of tissue grafts, which begins with transcartilaginous and transfixion incisions, followed by a subperichondrial dissection extending beneath the cartilaginous vault. The upper lateral cartilages are separated from the septum, and fibrotic tissue on the concave surfaces is removed. A standard septoplasty using the Killian method straightens the septum. Scar tissue from contractures is released through complete subperichondrial dissection on the mucosal side and partial dissection on the cutaneous side. To support healing and preserve dorsal projection, radiographic film strips or sterile silicone bands are applied in a sandwich-like configuration and removed after 5 days; the external splint is removed after 10 days. This technique avoids grafts by relying on intrinsic nasal structural elements. In 70% of cases, satisfactory anatomical correction is achieved without further intervention, whereas 30% require minor refinements. Importantly, no postoperative respiratory impairment has been observed, underscoring the technique's effectiveness in both aesthetic and functional nasal reconstruction.