I had Rhinoplasty done in 1992 and had to have it redone because the bone healed crooked and I was having bad headaches. My nose still healed crooked, but better then the first time. When I had my last surgery, the doctor was going to fill in the side of the septum with ear cartilage, but decided not to because the septum straightened right out during the surgery. She kept the bandages on an extra week to try to keep my septum straight. Still the same S shape occurred. Should i have it done again? Could there be something about my bone structure that makes my nose heal this way? Should my nose have been made smaller than it was?
Is my Bone Structure Making my Septum Heal Crooked?
Doctor Answers 4
Crooked septum can return even after correction
Once the septum is crooked, it has memory to fall back in the same position even after it is manipulated. There are many ways to "break the memory" and this is usually first done with a resection of the most deviated part internally. The parts removed are often used to bolster the main frame of the septum to straighten it. This can also be reinforced with sutures. But as you said, if the bones are not straight, then the septum will not be straight. Even when all parts are straightened, I tell patients that I can make it straighter, and better, but never perfect! It almost never is perfectly straight, because everyone has assymetry of their face.
You need internal support to prevent the problem
It seems that everytime your septum is manipulated, it wants to heal in the same position. To me, it indicates that you septum has memory to it. Internal support procedures, such as extended spreader grafting and septal buttress grafts, after septal weakening procedures may help you avoid this in the future.
Another thing that I have noticed with some patients is that they have a little restriction in the motion of skin on the bent side which may make it easier for the septum to rebend to the side that doesn't want to move very well. I think postop taping can help this.
Go back to your surgeon and discuss what they did to prevent rebending at your last surgery. I do agree with Drs. Mayer and Persky that a visit to a revision rhinoplasty specialist may be quite educational for you. You would do well to see Dr. Toriumi, as his reputation is stellar. Good luck.
Structural Support to Keep Nasal Septum Straight
Hi Pin Up Girl,
It is difficult to answer your question without examining your nose. It does sound as if your nose requires additional structural support. Your surgeon sounds as if she did her best, and sometimes we make decisions during surgery to help the patient maximally while avoiding unnecessary morbidity and expense (harvesting and using an ear cartilage graft). If your nose still bothers you, speak with your surgeon.
You are fortunate to live in an area where one of the world's top revision rhinoplasty expert practices in Chicago, Ill. (Dean Toriumi, MD).
Good luck and happy Holidays.