Am I a candidate for a septoplasty? (Photo)

Based on your photos, you appear to have thin nasal skin and an s-shaped nasal appearance. To achieve a straighter nasal appearance, I suspect you would require osteotomies and a spreader graft. Please meet with several reputable rhinoplasty specialists who offer computer Imaging so you could see what to expect from a cosmetic and functional standpoint after surgery. Thank you. Sincerely, Dr Joseph

You may very well have a crooked septum, but fixing a crooked septum does not straighten the nose from the outside. It will improve breathing, but you would need a rhinoplasty to make the outside straight as well. Be sure to see a rhinoplasty expert for consultation.

Whether a septoplasty could help your breathing depends on what the septum looks like inside the nose, and we can't tell that without an in-person visit. Concerning the twisted tip: that kind of asymmetry is extremely hard to correct, but there are considerations that make it much more possible to correct. For example, you didn't post a profile view, but if your profile view shows that you might like your nose better if the bridge were lowered, even a little bit, that work on the bridge would open many possibilities for the bridge to be straightened more during surgery. Also, if the tip of the nose is strong in its forward projection, bringing the tip and nose back closer to the face, would help create a straighter nose from the front, and could also open the nostrils a bit, and the narrow nostrils might be a factor in the breathing problem. So it's hard to give you any definitive answers right now. Certainly an in-person visit would help, but even without that, a much more complete set of photos might help as well.

In case you do decide that other changes could be made, how *much* to lower the bridge, or move the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs -- particularly work on the asymmetries -- require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

I recommend a rhinoplasty and septoplasty. The dorsal bone and cartilage needs to be straightened as well as the septum.

Best Wishes,

Gary Horndeski, M.D.

A septoplasty alone will not straighten the nose. You need a more complete rhinoplasty . However even in that scenario it’s difficult to completely straighten the nose, but it would be better

To ensure the integrity of the anatomy of the nose, you need to perform rhinoplasty; septoplasty or tipplasty alone will not be enough.

A thorough internal examination of your nose is required to make a determination about having deviated septum. You cannot see your septum from the outside of your nose. A rhinoplasty is performed to straighten the crooked nose, while a septoplasty form to improve your airflow dynamics in the back of the nose when there is a deviated septum president. Both a septoplasty and a rhinoplasty can be performed simultaneously under one anesthesia with one recovery.

Dear Mstar,
Yes, it appears that you would benefit greatly from a septorhinoplasty (combined septoplasty and rhinoplasty), and probably need a turbinectomy as well. An enlarging turbinate could be the explanation for your worsening breathing. That can only be determined with an internal nasal examination (or CAT scan). You also appear to have an external valve collapse that might be contributing to your breathing difficulty and would require some nostril rim cartilage grafting to correct. Seek consultation with an American Board of Plastic Surgery board certified plastic surgeon for an examination and discussion of your needs and options. Good luck!