Asymmetric Osteotomies in Structural Rhinoplasty: A Pisa Tower-Inspired Approach for Crooked Noses

Background: The Pisa Tower Concept, originally described by Finocchi et al, corrects bony vault deviation through asymmetric osteotomies without dorsal reduction. This study evaluates a structural adaptation in which asymmetric osteotomies are integrated into a structural workflow including dorsal hump management and septal reconstruction. Objectives: The objective of this study was to assess the effectiveness, safety, and satisfaction of Pisa Tower-style osteotomies as an adjunct to structural rhinoplasty for crooked nose. Methods: A retrospective analysis was conducted on 37 patients undergoing structural rhinoplasty for crooked nose deformity. Osteotomies were adapted from the Pisa Tower model: low-to-low or high-to-low lateral osteotomy on the concave side, wedge resection on the convex side, and transverse or oblique osteotomy depending on deviation origin. All patients underwent endoscopic L-strut septoplasty, dorsal hump removal, and tip support with a septal extension graft. Outcomes included pre- and postoperative CT-based R-Webster angles, nasal axis deviation, a 5-point Likert satisfaction scale, and complications, after a mean follow-up of 18 months (range 12-28). Results: = .18). Overall, 89.2% of patients rated satisfaction as 4 or 5. Minor complications occurred in 13.5%; none were major. Conclusions: In this preliminary report, Pisa Tower-style asymmetric osteotomies may represent a promising adjunct to structural rhinoplasty for the correction of bony nasal deviation, extending Finocchi's concept to a structural framework. Level of Evidence 4 Therapeutic: For image description, please refer to the figure legend and surrounding text.