Crooked Nose and Functional Rhinoplasty: Examination and Surgery
A crooked or collapsed nose is not only a cosmetic issue. When the external framework of bone and cartilage is misaligned – often following a nasal fracture – it can obstruct airflow, even if the nasal septum has already been straightened.
Functional rhinoplasty corrects the external shape and structure of the nose to improve airflow. At Charlottenlund Private Hospital, the procedure is performed by ear, nose and throat specialist Thorbjørn Hermanrud.
What is functional rhinoplasty?
The nose consists of an external nasal framework made of bone in the upper part and cartilage in the lower part, as well as an internal nose containing the nasal septum and nasal turbinates.
According to a 2025 review article in Ugeskrift for Læger, the nasal septum supports the bridge of the nose, the nasal tip and the wall between the nostrils.
The external and internal parts of the nose are therefore closely connected: if the external nose is crooked, the septum is usually also deviated, and if the cartilage lacks sufficient support, the sides of the nose may collapse inward when you breathe in.
During functional rhinoplasty, the parts of the bone and cartilage that obstruct airflow are corrected, and the supporting structures of the nose are reconstructed. The procedure differs from cosmetic rhinoplasty in its purpose: it is performed to correct a functional problem.
Why does the nose or nasal bridge become crooked?
The most common cause is a previous nasal fracture. Nasal fractures are the most common fractures of the face, and according to a review article in Ugeskrift for Læger, between 6% and 50% of patients experience persistent nasal congestion or a crooked nose after the fracture has been repositioned, while 9–17% later require surgery.
Injuries to the cartilage of the nose can cause the same problems, even when the nasal bones have not been fractured.
In other people, the nose has simply grown crooked, or the nasal cartilage is naturally so soft that the sidewall of the nose is pulled inward during inhalation.
What symptoms can a crooked or collapsed nose cause?
Typical symptoms include nasal congestion on one or both sides, often worse during physical exertion and at night, when many people need to breathe through their mouth, snore and sleep poorly.
Some notice that airflow improves when they gently pull the cheek outward with a finger – a sign that the obstruction is located at the front of the nose.
The nose may be visibly crooked or collapsed, but it is the breathing problems that determine whether surgery is indicated.
When can a broken nose be operated on?
A recent nasal fracture should be assessed within the first few days – either in an emergency department or by an ear, nose and throat specialist – because according to Ugeskrift for Læger, the fracture is usually repositioned five to seven days after the injury, once the swelling has subsided.
Recent nasal fractures are not treated at Charlottenlund Private Hospital.
If the nose remains crooked or blocked after the fracture has healed, the resulting problems can be treated surgically – but no earlier than 6 to 12 months after the injury, once the bone, cartilage and scar tissue have fully settled.
At that point, it is assessed whether the symptoms are caused by the nasal septum, the external nose or both.
How is septoplasty performed?
Septoplasty is performed through the nostrils. The surgeon makes a small incision inside the nose, exposes the nasal septum and straightens it by adjusting the parts of the cartilage and bone that curve outward so that the septum fits properly within the nose again.
The operation is performed under general anaesthesia and takes approximately one hour. It takes longer if the nasal turbinates, nasal polyps or sinuses are also operated on at the same time.
There are no visible scars, and the external shape of the nose does not change.
Thin silicone splints are often placed along the nasal septum to hold it in position while it heals. Nasal packing is not used.
Patients are observed after the operation and go home the same day.
If the symptoms are also caused by the shape of the external nose, correction of the external nose may be considered. This procedure is also performed at Charlottenlund Private Hospital and is arranged separately.
Septoplasty
- Straightens the nasal septum inside the nose
- Does not change the external shape of the nose
- Sufficient for most people with nasal obstruction
- Follow-up available at all locations
Functional rhinoplasty
- Straightens the external framework of bone and cartilage
- The external shape of the nose may change
- Used when the external nose is part of the problem
- Follow-up in Charlottenlund
How is the operation performed?
The operation is performed under general anaesthesia. The bone and cartilage of the nose are straightened, and if the nasal septum is deviated, it is corrected during the same procedure.
Enlarged nasal turbinates can also be reduced at the same time if this has been agreed in advance.
The aim is to improve airflow, and the shape of the nose is changed only to the extent necessary to improve function. Because the external nose is straightened, its appearance may change, and this is discussed thoroughly during the preliminary examination.
Patients are observed after surgery and go home the same day.
What can you expect after the operation?
For the first few days, the nose will feel blocked and tender, and there may be swelling and bruising around the eyes.
The nose should be rinsed with saline, and it is helpful to sleep with the head elevated during the first few nights.
The follow-up appointment takes place after approximately 10 days in Charlottenlund, where any silicone splints are removed.
According to Ugeskrift for Læger, strenuous physical activity should be avoided for a couple of weeks after nasal surgery, while sports and activities involving a risk of being hit on the nose should be avoided for two to three months.
The length of time you need to take off work depends on your occupation and is agreed with the surgeon.
Heavy bleeding, increasing pain, swelling or fever should be assessed by a doctor.
The treatment pathway at Charlottenlund Private Hospital
The treatment pathway begins with a preliminary examination by an ear, nose and throat specialist, during which it is determined whether the symptoms are caused by the nasal septum, the mucous membrane or the external nose.
If functional rhinoplasty is appropriate, the procedure is planned with the surgeon, Thorbjørn Hermanrud, in Charlottenlund.
The operation and the follow-up appointment approximately 10 days later both take place in Charlottenlund.
Referral and payment
Functional rhinoplasty may be covered by private health insurance when the procedure is medically justified by a functional problem.
Insurance companies typically require a referral from your GP and prior approval, and the insurance company decides whether the procedure is covered.
Self-paying patients do not require a referral, and prices are available in the price list.
Read also about
Frequently asked questions
What’s the difference between functional and cosmetic rhinoplasty?
Functional rhinoplasty is performed to improve breathing through the nose. Cosmetic nose surgery is performed to change the appearance of the nose. The techniques are similar, but the purpose is different.
What is septorhinoplasty?
An operation that straightens both the nasal septum and the outer framework of the nose, made of bone and cartilage.
Does the operation change the appearance of the nose?
The aim is to improve airflow, and the shape is changed only as much as necessary. Since the outside of the nose is straightened, its appearance may change; this will be discussed at your initial consultation.
Can an old broken nose be corrected?
a. The effects of a previous nose fracture can be treated with surgery, but only 6 to 12 months after the injury, once the nose has healed. A recent nose fracture, on the other hand, should be assessed within the first few days at an emergency department or by an ear, nose and throat specialist.
Does private health insurance cover functional rhinoplasty?
may be covered when the procedure is medically necessary to address a functional problem. Your insurance provider decides whether it is covered, and a referral and pre-approval are typically required.
When can you exercise after the operation?
Wait a couple of weeks before doing strenuous physical activity, and avoid sports where your nose could be hit for two to three months.