Hybrid Technique in Crooked Nose Correction: Evolution of the Asymmetric Letdown Approach.

Background: Crooked nose deformities remain a surgical challenge due to complex asymmetries of bony and cartilaginous structures. The “Hybrid Technique” combines preservation and structural rhinoplasty principles to improve correction while maintaining procedural efficiency. Methods: A retrospective study was performed on 54 patients who underwent primary rhinoplasty for crooked nose correction between January 2023 and June 2024. The first 28 consecutive patients were treated with the Pisa Tower technique, and the subsequent 26 with the Hybrid Technique. Baseline demographic and clinical characteristics were comparable between groups. Objective outcomes included nasal axis deviation and R-Webster triangle symmetry measured from standardized photographs and CT scans by two blinded reviewers. Functional results were assessed using the NOSE questionnaire at 12 months. Postoperative changes were analysed using linear regression models adjusted for baseline values, and standardized effect sizes with 95% confidence intervals were calculated to quantify between-group differences. Operative time and postoperative complications were also recorded. Results: Both techniques achieved significant improvement in nasal alignment (p 0.05). NOSE scores improved markedly in both cohorts (Hybrid: 76.8 → 19.4; Pisa Tower: 74.9 → 21.1; p 0.05). Adjusted effect sizes were small with confidence intervals crossing zero (e.g., nasal axis deviation d = –0.18, 95% CI –0.73 to 0.37), confirming the absence of meaningful between-group differences. NOSE scores improved similarly in both cohorts, and operative time and complications were comparable. Operative time was comparable (119 vs. 122 minutes; p = 0.42). Minor dorsal hump recurrence occurred in one Hybrid and three Pisa Tower cases, with no revisions required. Conclusions: The Hybrid Technique provides reproducible correction of nasal asymmetry with functional outcomes, complication rates, and operative times comparable to the Pisa Tower approach, representing a versatile option for complex nasal deviations.