Rhinoplasty in the deviated nose: patterns of recurrence and role of facial asymmetry

  • Yves L. J. GoffartEmail author
  • Sarah Remacle
Original Paper



Various hypothesis concerning recurrence of nasal deviation have been proposed in the literature but are not clearly demonstrated.


This retrospective study including 50 consecutive patients with a non-traumatic deviated was conducted to determine the pattern of nasal axis stabilization after rhinoplasty of the deviated nose on the basis of three anthropometric measurements: median face axis (MFA), interpupillary meridian axis (IMA), and scoliosis angle (SA). We studied possible mechanisms associated with progressive re-deviation occurring over time even to a very slight degree in many patients, and we reviewed the mechanisms associated with asymmetry of the face and nose. The hypothesis regarding recurrences and possible modification of surgical procedures are discussed. We retrospectively examined the pattern of recurrence of deviation over time in a consecutive series of non-traumatic patients undergoing primary esthetic or functional rhinoplasty. Patients were followed at 1 week, 2 weeks, 1 month, 3 months, and 1 year.


Of the patients, 92% (46/50) had an asymmetric face after comparing two anthropometric angles: MFA and IMA. Gradual re-deviation occurred in almost every patient, although very slightly, as MFA shifted from 4.1° ± 3.1 preoperatively to 1.0° ± 1.1 at 2 weeks, 1.1° ± 1.5 at 3 months, and 1.7° ± 2 at 1 year. IMA shifted from 4.7° ± 3.3 preoperatively to 0.9° ± 1.7 at 2 weeks, 1.5° ± 1.9 at 3 months, and 1.6° ± 2.8 at 1 year. SA shifted from 171.7° ± 6.2 preoperatively to 179.7° ± 1.4 at 2 weeks, 178.7° ± 3 at 3 months, and 177.8° ± 3 at 1 year. Stabilization was observed after 3 months to 1 year.


Facial asymmetry is present in most patients with a deviated nose. Nasal deviation often recurs, even after adequate surgery. The re-deviation pattern is progressive over the first few months after surgery. Midfacial hypotrophy may play a role in the formation of bony foundation defects of the nose and dynamic and asymmetric soft tissue forces over time. For the “facial envelope theory,” designing a surgical approach that would test this hypothesis is needed.

Level of Evidence: Level III, therapeutic study.


Crooked nose Deviated nose Facial asymmetry Outcomes Rhinoplasty 


Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical approval retrospective studies

Accepted by Belgian ethical committee.

Conflict of interest

Goffart Y., Remacle S. declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of ENT and Head Neck/MaxilloFacial SurgeryCHR CitadelleLiegeBelgium

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