Bay Area Septoplasty doctors

My strongest advice to you is to wait at least 1 year from your initial septo-rhinoplasty surgery before considering revision surgery.  You’ve been patient enough to do that – so good job!   Patients are often surprised at how much change can take place so long after their initial surgery – so much so that revision surgery is sometimes no longer even considered. 

If your problems do persist more than a year after the surgery, certainly revision surgery could be considered.  Multiple revision surgeries, however, should be avoided.  Very careful planning and consideration of your revision procedure should take place before you proceed.  Sometimes, simple steroid injections can improve the apparent larger size, and even the apparent shift to the left, if this is related to scarring of the soft tissue in the nose.  Any revision procedure should involve a very detailed analysis and carefully tailored individualized plan.

The most common septoplasty incisions are known as the “hemi-transfixion” or “complete transfixion” incisions. 

The use of a complete transfixion incision, which goes from one side of the septum all the way through to the other side, will most often result in a reduction of the height of the nasal tip by 1-2 millimeters.  If this is desirable, because the projection of the nose away from the face is slightly greater than ideal for your face, then this would likely be the best approach. 

Alternatively, a hemi-transfixion incision technique employs an incision on 1 side of the septum only so that there is little change in the nasal tip post-operatively.  The incision may also be made in the immediate area of the deformity in the nasal septum; however, I use this approach less commonly since I have less control of its effect on the other side of the septum, in this case.  I generally prefer to use a hemi-transfixion incision, unless there is a desire to drop the height of the nasal tip.

When teaching surgical residents about how to manage patients with symptoms like yours, I often tell them that we should “treat the patient” rather than treating the x-ray.  What’s more important to me than your x-ray findings is the symptoms that you’re describing and what I would find on physical examination. 

I would be looking to determine whether or not your nasal septum is crooked enough to obstruct your nasal airway, and to see if it’s crooked in an important location as it relates to your breathing function (the most important locations related to adequate nasal airway are the “interior” nasal valve area and “posterior” nasal valve area).

In addition to straightening the nasal septum – the structure that is in the midline of the nose, dividing the left nasal airway from the right nasal airway - you may also consider addressing the “nasal turbinates”.  The nasal turbinates are located on the outside walls of the airway.  These can become swollen enough to obstruct the airway due to nasal allergies or simply as a result of your natural anatomy.  They can either be reduced in size – my most common recommendation – or even removed.  Often, reduction of the nasal turbinates can be performed at the same time as a nasal septoplasty, if appropriate.  There is often little downside in adding this to the septoplasty procedure.