At the time of initial accident bleeding, head injury and other life threatening conditions have priority ,Nose is not very important at that time usually managed by Junior on call doctors or not so experienced doctors, after the initial period these otherwise normal persons when they see themselves in mirror they have severe psychological disturbances

Case 1- One soft ware engineer had a accident head injury facial trauma was hospitalized for several days recovered from head injury ,the nasal fracture was reduced ,after the healing completed ,he had a sever saddle nose deformity hated himself for the disfigured face , left job and confined himself inside house,

Case -2 A house wife survived in a major Car accident lost a closed family member ,primary care was given at the site and moved to a large hospital several days of hospitalization ,attempted Fracture nasal bone reduction but left with a ugly depressed nose. She adopted a deep silence and stopped talking to any one except the bare minimum .Otherwise a beautiful lady disfigured nose after accident seeing a psychiatrist and taking anti depressant

Case 3- A factory worker injured his nose on work deep cut and multiple fracture ,sever bleeding ,fracture reduction with repair of lacerated wound done but left with a sever depressed crooked nose with nasal obstruction Secondary Rhinoplasty in these cases have limitation ,a thorough counselling is required and they should understand they may not achieve the pre injury nose, the scars may be less visible but they cannot disappear

Current management techniques for acute nasal fractures result in a high incidence of posttraumatic nasal deformity). Associated traumatic oedema, pre-existing nasal deformity, and occult septal injury account for Nasal deformity following acute trauma represents one of the most common reasons that patient seeks Rhinoplasty.
The functional and Cosmetic problems incurred after injury might prompt an individual who would otherwise not considered surgery to seek treatment. As such these individual might have expectations different from purely cosmetic Rhinoplasty patients .Correction of post-traumatic nasal deformity requires attention to numerous defects and anatomical scenario.