The Septum is an anatomic component of the nose. The septum is of significant structural importance, as it provides support to the nasal vault and nasal tip. Anatomic deviation, injury, or deformity of the nasal septum can lead to nasal vault deformity, collapse or nasal airway obstruction. A significantly deviated nasal vault will usually have a deviated nasal septum. With most displaced nasal fractures, the septum often buckles and fractures, or deviates from its normal anatomic position. Frequently with nasal trauma, the septal cartilage fractures and the nasal mucosa on that septum tears. This can result in a severe nose bleed, or epistaxis. Often, cartilaginous fractures are not as easily visualized as boney fractures, when evaluated with Xray or CT imaging.
The term Septoplasty is frequently used to describe surgical correction of the nasal septum without addressing the "visible external nose". A Rhinoplasty is often used to describe correction of the external nasal components for either cosmetic or reconstructive purposes. Septo-Rhinoplasty defines the combination of both procedures, which can be misleading. Sometimes the septum has to be corrected in order to address the external form and function of the nose. The opposite holds true as well.
Many of the procedures that alter the shape of the septum and improve nasal airway, can also affect the shape of the nose. Many of the maneuvers that open up the internal nasal valve to improve airflow, can also straighten the nasal vault and effect the overall aesthetic appearance of the nose. The septum and nasal vault are converging components of the nose. Straightening a deviated nasal septum will help straighten a deviated nasal dorsum, and vice versa.
External valve collapse (or nostril collapse) is another cause of nasal airway obstruction. This is usually seen after trauma or a prior rhinoplasty where too much cartilage was removed form the tip (the lower lateral cartilage were over resected).
In the US, most nasal surgeries that get authorized by medical insurance are performed to treat nasal trauma or nasal airway obstruction.
The short answer is that Rhinoplasty to reshape the external nasal framework, is unlikely to result in further breathing improvement after a successful septoplasty and turbinate reduction. This is especially true in the absence of nasal valve collapse, which is otherwise a good indication for additional surgery.
Not an easy answer, as it requires a comprehensive evaluation by a specialist to help determine which of many factors contribute to an individuals nasal congestion symptoms. If a patient has a deviated septum, then the surgeon may suggest performing septoplasty with rhinoplasty. However, both procedures are not required all the time in combination. Speak with your surgeon if you want to try to further improve breathing.
A septorhinoplasty is a combination procedure. The "septo" portion being the functional aspects and the "rhinoplasty" portion being the aesthetic or cosmetic aspects of the surgery. So septoplasty and rhinoplasty combined together are simply called a septorhinoplasty and this procedure is done routinely. When needed I always address the functional aspects of the nose even when doing just a "cosmetic" procedure due to the fact that when you reduce the size of the nose you do not want to cause breathing difficulties that were not present before. Most patients who are looking for both function and aesthetics have septorhinoplasty performed rather then doing this in two separate procedures. Since you have already had sepoplasty there is no reason a rhinoplasty can not be performed now to address your cosmetic concerns. I suggest a consultation with digital imaging to help provide you a picture of your proposed surgical results.This will ensure you and your surgeon are on the same page. Best regards, Michael V. Elam, M.D.