Background: Correction of a crooked nose is one of the most difficult surgeries in rhinoplasty. Although different treatments for crooked nose surgery have been developed, the best treatment option remains debatable due to the intricacy and diversity of the deformity.

Aim: This study aims to compare functional and aesthetic outcomes between a unilateral and bilateral spreader grafts with columellar strut in management of C-shaped crooked nose. 

Methods: Twenty patients with C-shaped deviated nose were recruited and assessed for eligibility at Al-Azhar University Hospitals (Al-Hussein and Bab El-Shaarya University Hospitals). Patients were divided into two equal groups;( group A) included patients treated with a unilateral spreader graft with columellar strut and( group B) included patients treated with a bilateral spreader graft with columellar strut, follow-up was 6 months. 

Results: The clinical C shaped nose, the Cottle’s test and the CT nose for deviation were improved in 90% of cases in ( group B )and 80% of cases in (group A) with no statistically significant differences between both groups. There was a statistically significant increase in the mean ROE among group B in comparison with group A (86±5.7 vs. 74.5±8.3, respectively) (P value=0.002). Regarding the post-operative complications, nasal blockage occurred in 3 patients (15%), contact dermatitis in 5 patients (25%), and scar hypertrophy in 3 patients (15%) and under correction in 2 patients (10%) of the studied patients.

Conclusion: Bilateral spreader grafts with columellar strut is superior to the unilateral spreader grafts regarding post-operative nasal assessments and the rhinoplasty outcome evaluation.