The deviated nasal dorsum diverges off the ideal vertical orientation at the midline. Deviations in the dorsum lead to functional and aesthetic effects, which often lead the patient to seek consultation with a rhinoplasty surgeon. The inability to breathe through the nose and the sense of self-image greatly diminishes the quality of life of the individual. The treatment of the deviated nasal dorsum is a problem for the rhinoplasty surgeon. The target is an anatomical correction of deviations.

Straightening a deviated nasal dorsum may involve procedures to re-align the nose distinct from conventional cosmetic rhinoplasty techniques. The nasal dorsum is shaped by the three-dimensional structure of the septum, the bony nasal pyramid, and the cartilaginous nasal mid vault. Restoring the stance of the septum at the midline is the first step towards providing sufficient support for the nasal architecture. Extracorporeal septoplasty and anterior septal transplantation are often requisite techniques for the correction of the septum and the correction of the back. Subsequently, asymmetric movements to the bone dorsum and mid vault are performed to preserve symmetry.

Asymmetric hump reduction and nasal osteotomy are also required. Supporting the mid vault to prevent nasal failure also includes asymmetrical maneuvering of the upper lateral cartilages and asymmetrical spreader grafts. Eventually, camouflage grafts to the nasal dorsum may be required. Significant stiffness and awareness of the native tissues must be resolved to effectively straighten the nose. The specialist who can monitor the deviated dorsum can greatly enhance the appearance and standard of life of the patients he or she is treating.

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