Correcting a Deviated Nose with Closed Rhinoplasty: A Real Patient Case at Noselab

A deviated nose is one of the most nuanced challenges in rhinoplasty. It involves not just cosmetic asymmetry but often functional concerns as well — affecting breathing, nasal airflow, and overall facial harmony. At Noselab Plastic Surgery, Dr. Chayoung Kang specializes in correcting nasal deviation through a closed rhinoplasty approach, leaving no external scars while achieving natural, balanced results.

In this case study, we walk through a real patient case in which closed rhinoplasty was performed to address a visibly deviated nose — restoring both structural alignment and aesthetic symmetry.

Understanding Nasal Deviation

A deviated nose occurs when the central nasal structure — including the nasal bones, upper lateral cartilages, and septum — shifts away from the facial midline. This deviation can be:

• Congenital — present from birth due to developmental asymmetry
• Traumatic — caused by injury, fracture, or previous surgery
• Functional — accompanied by a deviated septum that obstructs breathing

Patients with a deviated nose often describe feeling self-conscious about the asymmetry, especially in frontal-facing photos. Many also report one-sided nasal congestion or difficulty breathing through one nostril.

Correcting nasal deviation requires a thorough understanding of the underlying structural causes — it is never a single-step fix. The nasal bones, cartilaginous framework, and septum must all be assessed and addressed in a coordinated manner.

Why Closed Rhinoplasty?

At Noselab, Dr. Kang performs the vast majority of rhinoplasty procedures using the closed (endonasal) technique. All incisions are placed entirely inside the nostrils, eliminating any external scarring on the columella.

The advantages of closed rhinoplasty for nasal deviation correction include:

• No visible scarring — incisions are hidden within the nostrils
• Less swelling and faster recovery — reduced disruption to nasal skin and soft tissue
• Preserved tip integrity — the natural support structures of the nasal tip are less disturbed
• More natural results — outcomes tend to look and feel more like the patient’s own nose

While some complex revision cases may require an open approach, the closed technique — when performed by an experienced specialist — is fully capable of addressing moderate to significant nasal deviation, osteotomies, septal correction, and cartilage grafting.

Patient Case: Before Surgery

This patient presented to Noselab with a clearly visible lateral deviation of the nose, most apparent on frontal view. The nose deviated toward the left side, creating noticeable asymmetry relative to the facial midline. On profile view, the dorsum showed mild irregularity, and the nasal tip lacked definition.

During consultation, Dr. Kang performed a thorough structural analysis including:

• Frontal, lateral, and basal photographic assessment
• Internal nasal examination to evaluate the septum and turbinates
• Palpation of the nasal bones and cartilage framework
• Discussion of the patient’s functional and cosmetic goals

The root cause of the deviation was identified as a combination of a deviated nasal septum and asymmetric positioning of the upper lateral cartilages, compounded by slight displacement of the nasal bones. A comprehensive surgical plan was developed addressing all three components.

Surgical Plan and Technique

Dr. Kang’s approach for this case involved the following steps, all performed through endonasal (closed) incisions:

1. Septoplasty

The deviated septum was the foundational issue. Septoplasty was performed to straighten the septal cartilage, restore midline positioning, and improve airflow. Harvested septal cartilage was preserved for use as grafting material later in the procedure.

2. Medial and Lateral Osteotomies

To reposition the deviated nasal bones, controlled osteotomies (bone cuts) were performed along both the medial and lateral aspects of the nasal bones. This allowed the bony pyramid to be mobilized and shifted toward the midline, creating a straighter dorsal profile.

3. Spreader Grafts

Spreader grafts — thin strips of cartilage — were placed between the septum and upper lateral cartilages. These grafts help maintain the corrected position of the middle vault, prevent internal valve collapse, and support long-term structural stability.

4. Tip Refinement with Cartilage Grafting

The nasal tip was refined using the patient’s own septal cartilage. Careful suture techniques and cartilage placement were used to improve tip definition and projection while maintaining a natural appearance consistent with the patient’s facial features.

Recovery and Results

Following surgery, the patient wore a nasal splint for one week to support the repositioned nasal bones during initial healing. Swelling was most prominent in the first two weeks, with significant improvement visible by the one-month mark.

At three months post-op, the results show:

• A visibly straighter nose on frontal view, aligned with the facial midline
• Improved dorsal smoothness on profile view
• A more refined and symmetric nasal tip
• Improved nasal breathing reported by the patient
• No external scarring — consistent with the closed approach

The final result blends naturally with the patient’s facial features. The nose looks balanced and proportionate — not operated-on — which is the hallmark of Dr. Kang’s closed rhinoplasty philosophy.

Key Takeaways

• Deviated nose correction requires addressing the underlying structural causes, not just surface appearance
• Closed rhinoplasty is capable of correcting significant deviation when performed by an experienced specialist
• Combining septoplasty, osteotomies, spreader grafts, and tip refinement delivers comprehensive, long-lasting correction
• Using the patient’s own cartilage (autologous grafting) supports natural, stable results
• Recovery is gradual — full results are typically visible at 6–12 months as residual swelling fully resolves

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