Dear Susancobos; In a broad sense, any procedure that changes the appearance and shape of the nose externally is a “rhinoplasty.” The reason: “rhino” means nose while “plasty” means a change. But with all issues at hand, including insurance companies that must understand what was done, rhinoplasty is considered a purely cosmetic procedure while reduction of nasal fracture is a functional operation.The difference? A rhinoplasty is typically done when the patient has never had an injury or change in nose shape and is merely unhappy with the nose given at birth. Correction of a broken nose as well as nasal septoplasty may be necessary if you had an injury 25 years ago.The septoplasty you had, hopefully, straightened the inside of the nose, corrected that deformity and allowed better breathing. However, if you were unhappy with the shape of your nose, the surgeon should have also recommended changing the outside to either match the pre-injury state or give you an even better nose than you had before that old injury. It's important to accomplish as much as you can during one surgery. The reasons are obvious and include: Efficiency of time One recovery, not two Significant dollar savings No return to the operating room for a sequel It's not too late to correct the problem. It may be that the septum must be operated on again because a crooked internal septum is often a contributor to the external crookedness of the nose.That's why, typically in an injury case, it's best to first address the crooked septum to improve the airway. By straightening the septum, there is a contribution also made to straightening the outside of the nose.An old adage in the world of nasal surgery says it all: “As the septum goes, so goes the nose.” I suggest returning to your original surgeon and asking if it would now be appropriate to make the external changes. However, it is very important that your surgeon is very experienced in that type surgery. Perhaps he was more comfortable just straightening the septum internally without taking on the outside changes. Frankly, it's much more difficult to make outside changes than merely operating on the septum. But you need to get a handle on what your surgeon is comfortable doing. If he is uncomfortable doing changes to the outside of your nose, just ask for your medical records and go to another surgeon who does a lot of nose surgery and who probably would find your case to be rather routine. So do your homework, read books, visit websites, and get a handle on what it takes to straighten a crooked nose. Best wishes, Robert Kotler, MD, FACS