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Rhinoplasty following Septoplasty?

asked 8 months ago by J_L
Latest answer by David Mabrie, MD
Question viewed 486 times
Tags: droopy, cartilage, deviated septum, pre-op, septorhinoplasty

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!

22 answers to Rhinoplasty following Septoplasty?

+1

Rhinoplasty revision or fillers?

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

www.bevhills.com

+1

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

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... more
David Mabrie, MD

Bay Area Facial Plastic Surgeon

yourfaceinourhands.com

+1

Rhinoplasty after septoplasty

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... more
William Portuese, MD

Seattle Facial Plastic Surgeon

www.seattlefacial.com

+1

Septoplasty: probably necessary. Rhinoplasty perhaps not.

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... more
Robert Kotler, MD

Beverly Hills Facial Plastic Surgeon
+1

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

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... more
Stephen Weber, MD

Lone Tree Facial Plastic Surgeon

www.lonetreefacial.com

+1

Rhinoplasty

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... more
David Alessi, MD

Beverly Hills Facial Plastic Surgeon
+1

Rhinoplasty Following Septoplasty

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
+1

Rhinoplasty following Septoplasty?

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
+1

Septoplasty

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
+1

Nasal deformity afetr septoplasty

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

www.plasticsurg.org

+1

Rhinoplasty after Septoplasty

Rhinoplasty after septoplasty can be tricky. It has to be handled the right way by someone with experience in cosmetic and functional surgery in order to avoid the issues you describe. It sounds like you had a submucus resection type septoplasty where the non-structural cartilage is removed. That is unfortunate but no uncommon either. What is left is the structural parts of the septum, also referred to as the L-strut. That L strut can be manipulated, provided the surgeon appreciates what... more
Richard W. Westreich, MD

Manhattan Facial Plastic Surgeon
+1

Rhinoplasty after previous septoplasty

A rhinoplasty may still be done after previous septoplasty, but you may need cartilage harvest from another source if requires. This is usally the ear and in severe cases rib cartilage may be used. You should see an experienced surgeon who is well trained in revision rhinoplasty. Donald R. Nunn MD Atlanta Plastic Surgeon.
Donald Nunn, MD, DDS

Atlanta Plastic Surgeon
+1

Rhinoplasty revision after septoplasty

Thank you for the photos . a profile view would be helpful. the nose can be re operated on but secondary surgeries are more complex , take longer and need a more skilled and experienced surgeon.. grafting may be needed. an open method preferred. a filler such as juvederm can give an idea as to how much it will help. if this is adequate a longer lasting filler such as radiesse can be used. so , there are several options depending... more
Jed H. Horowitz, MD

Orange County Plastic Surgeon
+1

Fixing the crooked nose

Provided you are now breating well, your chief complaint is aesthetic. The nose must then be evaluated from the front, sides, and nostril view to determine which structures are causing and/or contributing to the crookedness, and any other existing aesthetic problems. A surgical plan must be developed, and adjusted depending on intra-operative findings. These can be challenging procedures, because all nasal structures are interconnected, and generally, complete mobilization of... more
Steve Laverson, MD

San Diego Plastic Surgeon

feelbeautiful.com

+1

Rhinoplasty after septoplasty

It is certailny possible to perform a rhinoplasty after septoplasty. You may need a spreader graft on the depressed side to camouflage the asymmetry. But remember, realistically the nose will never be perfectly straight.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Crooked nose

You definitely need a rhinoplasty and you need to see a surgeon with comfort and experience in deviated noses and revision noses. One additional challenge you now have is in the availability of nasal septal cartilage for grafting. To lift out and repair the concavity (deptession) you have on the left will likely require spreader grating. Since we don't know how much of your septum may have been removed during the previous surgery you may require ear cartilage grafting. These... more
Michael L. Schwartz, MD

West Palm Beach Plastic Surgeon

www.palmbeachface.com

+1

Rhinoplasty after Septoplasty- Using septal Cartilage to shape nose

It is possible to have a rhinoplasty done after a septoplasty, although it is best to have them done at the same time so that the removed septal cartilage can be used to rebuild and reshape the nose during rhinoplasty. The nasal wall dent or deformity that is apparent in your picture can be corrected by cartilage grafting to the area of the upper lateral cartilage which would most likely be done in a form of a "spreader graft". If you don't have much septal cartilage left after... more
S. Sean Younai, MD

Beverly Hills Plastic Surgeon
+1

Rhinoplasty for crooked nose can be successful after septoplastu

Dear JL To be short and sweet with this answer, your nose can be made More straight and your breathing better with a revision septiplasty and rhinoplasty . Seek another consult with a facial plastic surgeon or plastic surgeon who specializes in rhinoplasty for another opinion. The septum is the base and strength of the nose and likely needs to be Repaired with an external rhinoplasty approach. I don't recommend fillers for this. Best wishes
Travis T. Tollefson, MD, MPH

Sacramento Facial Plastic Surgeon

www.drtravistollefson.com

+1

Rhinoplasty or "Secondary" Septorhinoplasty after Septoplasty

Dear JL, Although ideally you should have performed a septorhinoplasty as the first operation, a secondary operation is quite feasible. Primary surgery is easier than secondary surgery, and if a septoplasty had not been performed, your surgeon would have had an abundance of the most ideal cartilage for all "building" purposes. You should visit with a surgeon who has experience with secondary rhinoplasty operations, and just understand that there is a higher... more
Michael A. Bogdan, MD

Dallas Plastic Surgeon
+1

Rhinoplasty after septoplasty

Hi. It is usually necessary to reoperate on the septum in patients who are still having problems breathing after a previous septoplasty. This can be done at the same time as a rhinoplasty and is often necessary to straighten a crooked nose. Your chance of a successful outcome is enhanced by seeing a plastic surgeon who is very experienced in rhinoplasty and revision (redo) rhinoplasty. Best of luck!
Richard Chaffoo, MD

San Diego Plastic Surgeon
+1

Rhinoplasty After Septoplasty Is Very Possible

It is absolutely possible to do a rhinoplasty after having had a septoplasty. It is probably true that you have a higher risk of having a septal perforation occur but this risk is still very small in the hands of a qualified surgeon. Ideally you would have had your rhinoplasty and septoplasty done together at your first surgery, but we can't go back in time and change that so there is no reason to fret over it now. It is important that you find someone who really enjoys... more
Louis W. Apostolakis, MD

Austin Facial Plastic Surgeon

www.dr-apo.com

+1

Rhinoplasty after a septoplasty

Hello, Rhinoplasty after a septoplasty is certainly possible. In fact, many of the rhinoplasties that I perform are after a failed previous septoplasty. Sometimes, a septoplasty can provide enough improvement on its own for breathing reasons. Most of the time, however, with the amount of deviation that you have (which is visible on the outside) a septorhinoplasty is necessary. This procedure would aim to straighten out the entire septum (particularly the portion that is deviated... more
Jamil Asaria, MD

Toronto Facial Plastic Surgeon

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