I have a deviated septum and shifted columella. What procedure is best for me? (photos)

I suffer from a deviated septum from an injury I had as a child. The tip of my nose feels completely bent to one side and nostrils are assymetrical. I recently visited my ent and he referred me to a rhinoplasty surgeon. I was not content with his answers. He said he could correct my deviated septum and the bump on the bridge of nose which is the least if my worries.He explained its very difficult to correct the tip and he suggested, i leave it alone. What procedure am I a good candidate for ?

Doctor Answers 10

I have a deviated septum and shifted columella. What procedure is best for me?

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The internal and external nasal areas that you described and would like improved can be addressed with a nasal surgery (rhinoplasty) and a septoplasty which are typically done at the same time. A natural appearing nose can be achieved when the procedures are performed by an artistic plastic surgeon with extensive experience in nasal surgery using either a closed or open technique.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you what to do based on a limited two dimensional photo without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would notbe in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) or facial plastic surgeon (otolaryngologist) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Correcting the deviated lower third of the nose

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From the pictures you submitted, it appears that you need a septoplasty to address the caudal septum which is the part of the septum near the very bottom of your nose. Your tip is also deviated and there are many techniques for correction but one simple approach might be to straighten your septum in the midline and suture your tip to the septum to maintain it in the middle called a "tongue and groove" technique. Good luck in your area. I would seek the advice of a facial plastic surgeon to correct your issue.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Caudal septal deviation

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You appear to have a deviation of the caudal septum.  This can be corrected by degloving the septum and using either a cartilage strut or sutures to return it back to midline.  

Deviated septum and shifted columella.

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Without an exam and discussion, exact details cannot be accurately given. However, you appear to have deviation of the dorsum and septum to the right of the midline. The nasal base view it tilted to the right as well. The nasal tip is wide and your lips are too full for your facial proportions.

A septoplasty to straighten the nose with medial and lateral osteotomies should provide a straight dorsum without spreader grafts. The nasal tip could be narrowed with mattress sutures at the dome of each lower lateral cartilage. The mid vault is not narrowed and therefore, spreader grafts would not be necessary after the nasal bones and septum were straightened. The procedure could be performed with either a closed or open approach depending on the skill and experience of your surgeon.

Steven J. Smith, MD
Knoxville Plastic Surgeon

Septoplasty and rhinoplasty candidate

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The septoplasty procedure is  performed for medical necessity which has to be documented as a medical necessity. A columellar- plasty can also be performed to straighten out the caudal septum and  reduce the columellar show.
The rhinoplasty procedure would involve shaving down the dorsal hump, straightening the nasal bones and adding a spreader graft on the concave side to give more symmetry. For many examples of crooked nose repair in our practice, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Well-performed septo-rhinoplasty surgery may result in a narrower tip and improved nostril symmetry.

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Based on your photos, you appear to have a nice nose. Your tip is a bit wide, but this does not necessitate correction. The asymmetry at the base of your nose may be from deviation of the bottom of your septum. Well-performed septoplasty surgery may lead to improved symmetry at the base of your nose.

Hope this helps you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

I have a deviated septum and shifted columella. What procedure is best for me?

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Full rhinoplasty with septaloplasty and cartilage spreader grafts. But see more Rhino surgeons... 

I have a deviated septum and shifted columella. What procedure is best for me?

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Your nose can achieve its maximum improvement by a standard rhinoplasty operation with correction of the deviated septum as well as refining some of the additional components of your nose.

I have a deviated septum and shifted columella. What procedure is best for me?

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You can have a more refined nose that is natural in appearance. I perform these surgeries with closed technique to preserve the structure of the nose and minimize visible scarring.

Kenneth Hughes, MD

Los Angeles, CA

Your tip asymmetry can be corrected

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The asymmetry of your tip will partially be corrected by correcting the deviated septum. If necessary, a cartilage strut can be placed into the

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 27 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.