Rhinoplasty following Septoplasty?

About a year ago I underwent a septoplasty to correct a severely deviated septum that resulted from a broken nose when I was younger. My surgeon removed what must of been sizeable bone spur that was obstructing the nasal passage which definitely helped with my breathing. Unfortunately, it did little to correct the aesthetic appearance of my nose. The septum is still very deviated midway up the nose so it has maintained its crooked appearance. This is due to the septum pushing out against the nostril while the other "droops".  Furthermore, my right nasal bone is caved in slightly due to the break adding to the appearance of crookedness/curve. When I consulted a plastic surgeon a bit later about the possibility of a septoplasty revision he said it would not be worth it considering a lot of cartilage was removed. This would make it hard to re-anchor/attach the septum and would also increase the risk of perforation. What can i do to fix this asymmetry? Is a rhinoplasty still possible? And what can be done about the crushed right nasal bone? I have considered fillers to even out the appearance of the curve and create symmetry. Though i'd want permanent results, Is this a better option?  Thanks in advance!

Doctor Answers (22)

Non-surgical Rhinoplasty is a predictable and safe option for concavities

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If it were my nose I would have fillers used.  A physician who is experienced in non-surgical rhinoplasty techniques could straighten your nose in 15 minutes in the office.  You could have this done first with temporary fillers which last a total of a year, with about half of the effect gone after 6 months. 

If you are happy with the doctor's technique you could then try a permanent filler like Artefill if you want.  I personally like the temporary fillers like Restylane and Perlane.  Because you only need a small amount, (especially for your nose) the remainder can be used in other places like under the eyes or in the cheeks or chin.

The advantage of avoiding the risks and side effects of surgery would outweigh the disadvantage of needing to repeat the treatment.

Good luck in your search for information!


Bay Area Facial Plastic Surgeon
4.5 out of 5 stars 56 reviews

Rhinoplasty after septoplasty

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The septoplasty operation is specifically designed to improve airflow dynamics through the nose, not to correct a crooked nose.  The concaved appearance of the upper lateral cartilages on one side or the other is best addressed by harvesting residual septal cartilage and placement of a spreader graft on the concave and flail side that has herniated into the airway.  If the nose is cartilage depleted, then a small ear cartilage graft can be employed.  Any irregularities in the bone will be addressed through osteotomies to make the nose more symmetrical.  

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

Septoplasty: probably necessary. Rhinoplasty perhaps not.

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Hello;

If the septum is still deviated, particularly if it's causing a nasal blockage, then the septum must be re-operated on. 

It sounds like it's needed because if it is distorting the lower portion or tip portion of the nose, then it does need to be corrected.  The revision rhinoplasty surgery will reveal that.

With respect to the outside of your nose: if straightening the septum straightens the outside, bravo! 

If it does not, however, another option may be, not necessarily a revision rhinoplasty, but rather  fillers instead to correct the depression, particularly on the right side. 

Only when the septum is straightened will the surgeon know exactly what it has, or has not, done.

My advice: have a very detailed re-consultation with the original surgeon.  Also, a second opinion is always worthwhile. 

Each surgeon must do a very thorough examination of the nose, particularly by anesthetizing and shrinking the inside so the existing architecture can be seen, as well as whatever tissues may have been removed in the original surgery. 

The more information a surgeon has, the better the choices that will be available to him and to you. 

Do not dismiss the filler option because it is very difficult often to get an ideally straight nose that is a bit crooked, and particularly if there is some depression of the bony or cartilaginous elements. 

Good luck!

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

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Rhinoplasty can be safely performed after septoplasty but seek an experienced surgeon

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Rhinoplasty can be safely performed after septoplasty but seek an experienced surgeon. An experienced Facial Plastic or Plastic Surgeon will be able to deal with the increased risks of revision septal surgery. The main limitation in performing rhinoplasty after prior septoplasty if finding adequate cartilage to rebuild the structural support of the nose. If this cannot be obtained from the nasal septum it can be readily obtained from the ear, cartilage portion of a rib or cadaveric donor tissue (my last choice due to some issues with warping and resorption). Fillers are a temporary solution and not without risk such as skin necrosis when used after prior nasal surgery. Further, fillers are camouflage. They are not a structural or permanent solution to your concerns.

Thank you for your question.

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 37 reviews

Rhinoplasty

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If the septum is still deviated internally, it can still be corrected to improve your nasal airway.  The is always a chance of perforation, but good surgeons can usually reduce the risks of that.  The external nose is treated separately from the septum.  An actually in-person examination is the only way to determine exactly what needs to be done.  However, it appears the upper lateral cartilages are asymmetric and the nasal bones may be off.  These are all problems that a Board-Certified Facial Plastic Surgeon can repair.

Good luck!

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 7 reviews

Rhinoplasty Following Septoplasty

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Fillers can be used to improve the asymmetry, but you say that you would prefer a permanent solution.  A rhinoplasty with cartilage grafts, probably harvested from the ears, is the best way to straighten the nose, improve the structural support, and improve the aesthetic appearance.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Rhinoplasty revision or fillers?

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Fillers are easy to balance a crooked well functioning nose. A revision surgery will do this permanently IF you choose an experienced revision rhinoplasty surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Rhinoplasty following Septoplasty?

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Septoplasty is to correct airway obstruction and will not correct depressions or crookedness of the nasal bones.  Rhinoplasty with osteotomies to fracture the nasal bones deals with that.  You may want to have several consults with Rhinoplasty surgeons to evaluate the nasal bone depression for possible treatment.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Septoplasty

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Yes Unfortunately, you should have had it all done at once. But, yes you can go the filler route or the surgical route. Select your surgeon carefully

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

Nasal deformity afetr septoplasty

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A revision of the nasal appearance after a Septoplasty I would consider a secondary rhinoplasty. Because of the septal removal this would be a difficult secondary rhinoplasty.I would therefore see someone with experience in secondary rhinoplasty surgery.

Jay M. Pensler, MD
Chicago Plastic Surgeon
4.5 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.