As an important organ of the human body, the nose is not only an important symbol of the aesthetic structure of the entire face, but also has complex physiological functions: breathing and smell. The nose is an important yardstick to measure whether the facial contour meets the aesthetic standards, such as the three chambers in the “three chambers and five eyes” in facial aesthetics, which is measured by the length of the nose. There are many aesthetic criteria to judge whether a nose is beautiful or not, such as the height of the nose root, the angle of the nose tip and the shape of the back curve of the nose. Therefore, a successful rhinoplasty requires a very high level of aesthetic quality from the plastic surgeon himself. Crooked nose is very common among nasal deformities and is a more complex rhinoplasty operation than simple rhinoplasty because, for the clinical treatment of patients with crooked nose, it is not only necessary to reconstruct the aesthetic sign of the nose, but also to restore the normal physiological function of the nose. Ellis and Gilbert define a crooked nose as “a nasal manifestation that deviates from the midline of the face without the absence of supporting structures” and describe a pseudocrooked nose as “the appearance of a crooked nose due to the absence of soft or bony tissue in the midline plane of the face. “. Thus, any deformity that produces a crooked nose can be classified as a crooked nose deformity. We draw a vertical line in the middle of the nose and a further intersection line from the point of the nasal root to the point of the nasal tip deviation, the distance between the two lines is used as a diagnostic criterion for external deformity, 3 to 5 mm is mild, 6 to 8 mm is moderate. 8 to 10 mm is severe. What are the causes of a crooked nose? A crooked nose is a nasal deformity caused by trauma or dysplasia of the cartilage and bone tissue of the nose. It is generally divided into congenital crooked nose and acquired crooked nose, the former is mostly cartilaginous deformity and the latter is mostly bone deformity. According to the site of distortion, it can be clinically divided into the following two types: one is cartilaginous distortion: the distortion is in the cartilage below the nasal bone, mainly in the lower part of the nose and the tip of the nose. The other is bony distortion: the distortion is mostly in the upper part of the nasal bridge and the root of the nose, mostly caused by the asymmetry of the bone tissue. A variety of methods have been used in clinical practice. The current viewpoint of plastic surgery is to unify the aesthetic reconstruction of the nasal shape and the reconstruction of normal physiological ventilation, i.e., to restore the isometric nature of normal airway ventilation through surgery, while repairing the subunit structure of the nose and restoring the overall aesthetic shape of the nose. Crooked nose repair Crooked nose deformity is a common clinical nasal disease in plastic surgery, with various etiologies, the most common being trauma. Due to the different causative factors, the clinical manifestations also vary. For different types of crooked nasal deformity, we should carefully observe its shape characteristics, analyze the site and structure of the crookedness according to the anatomical characteristics of the nose, and adopt a targeted and personalized surgical method for each patient. For patients with asymmetrical nasal bones, nasal osteotomy is performed to adjust the size and position of nasal bones on both sides; for patients with deviated nasal septum, septoplasty is performed at the same time, and if the nasal septal cartilage is dislocated, it is reset; for patients with obvious deviation of the lower part of the nose, chondroplasty is performed to partially remove the lateral nasal cartilage on the overdeveloped side. As for the acquired secondary crooked nasal deformity, due to external impact or pulling, it is mostly manifested as nasal bone fracture deformity, nasal septum fracture and dislocation, but the nasal cartilage is elastic and not easily damaged, so the deformity of the lower part of the nose and nostrils is less frequent. For patients with nasal bone fracture deformity, nasal bone osteotomy is performed to adjust and reset the nasal bone; for patients with nasal septum fracture, nasal septum correction is performed at the same time, and those with serious misalignment can be sutured and fixed. Radiological incision of the septal cartilage is mainly used for nasal tip shaping, as the cartilage moves upward or downward, the nasal tip also moves upward or downward as a whole. In septal cartilage correction surgery, the severed cartilage is generally redistributed to the dorsal and apical regions of the nose. We believe that it is more in line with the scientific treatment of crooked nose by individualizing the evaluation of the crooked bone and cartilage of each patient and choosing a different procedure based on the aesthetic criteria of the nose and the requirements of the physiological function of ventilation. Now we have done some cases and the patients’ results are still very good. For crooked nose deformity, we may focus on a certain point, either the nose should look good or the function should be improved, we think these two points should be very well combined together to be a most successful treatment result.