Successful correction of the deviated nose is accomplished when all anatomic constituents involved in the defect are adequately identified and surgically straightened. However, in the rhinoplasty algorithm, septum abnormalities and septal surgery are often underestimated, and inaccurately labelled as “complementary” to tip surgery or nasal vault surgery.

As a rule, septoplasty is performed to correct breathing problems, but often it becomes pivotal to correct external nasal deviation, representing a central step in rhinoplasty surgery. Even in patients with no functional problems, septal surgery may represent one solution for obtaining a proper realignment of the external nasal pyramid. Therefore, the septum deserves attention not only for functional, but also for aesthetic surgery.

The multidisciplinary improvement obtained from the knowledge of the anatomy, physiology and surgical techniques about internal and external nasal surgery provide the conclusion that they are inseparable. In fact, surgeons from several specialties (head and neck surgeons, oral and maxillofacial surgeons, plastic and reconstructive surgeons) have actively concurred to create a more extensive scientific background, providing functional and cosmetic improvements in the literature of their respective fields. Hence, each rhinoplasty surgeon, regardless of specific training, needs a firm knowledge of both the functional and cosmetic aspects of this surgery.

The aim of this article is to discuss the close relationship between the nasal septum and the aesthetic of the nose, and how a graduated surgical approach for the correction of septal deviations can affect the external deviated nose.


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