Considering a rhinoplasty to correct a deviated septum that causes sleep apnea. Would a PS or an ENT deliver optimal results?

Question

I like my nose and wouldn't have a nose job otherwise but I can't breathe at night. I the procedure is going to alter the look of my nose, I want it to be done by someone who can make it look really good and hardly noticeable. Are all plastic surgeons adept at truly fixing deviated septums? Or do I have to go to an ENT? Help!

Guray Yesiladali, MD, FEBOPRAS · Answer

The decision between a plastic surgeon (PS) and an ear, nose, and throat (ENT) specialist for a rhinoplasty to correct a deviated septum that causes sleep apnea will depend on a number of factors, including your individual anatomy, the severity of your sleep apnea, and your cosmetic goals.Both plastic surgeons and ENT specialists can perform rhinoplasty procedures to correct a deviated septum. However, ENT specialists have a more extensive knowledge of the anatomy and function of the nose, and are often better equipped to handle complex cases involving breathing difficulties.If you have a significant deviation of the septum and are experiencing symptoms of sleep apnea, an ENT specialist may be the better choice for your procedure. We can assess your anatomy, determine the cause of your sleep apnea, and recommend the best surgical approach to correct the problem.If you also have cosmetic concerns about the appearance of your nose, a plastic surgeon may be better equipped to address these concerns and help you achieve the desired cosmetic outcome.Ultimately, the best way to determine the most appropriate specialist for your needs is to consult with both a plastic surgeon and an ENT specialist and discuss your individual case and concerns. We can help you make an informed decision and determine the best course of action for you.

Nima Shemirani, MD · Answer

Hi @cory19! I would recommend going to a facial plastic surgeon considering you are correcting the deviated septum and making cosmetic changes. A rhinoplasty in my opinion is one of the most difficult procedures to perform. The skill, artistry, and technique of the surgeon determines the outcome. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. I hope this was helpful!

Jonathan Kulbersh, MD · Answer

Thank you for your question. When looking to treat breathing issues and make cosmetic changes at the same time, it would be best to find a facial plastic surgeon who is experienced in performing both septorhinoplasty and rhinoplasty procedures. The surgeries can be combined to address multiple concerns at once and produce the most favorable results with less recovery time.

Keep in mind that rhinoplasty of any kind is one of the most complex of all plastic surgery procedures, requiring experience, skill, and even artistry to achieve an optimal outcome. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon, with expertise in septorhinoplasty and rhinoplasty techniques. They will be able to review your medical and cosmetic concerns and determine the necessary steps to help you achieve your desired results.

Gianfranco Frojo, MD · Answer

You need a surgeon that is just a good rhinoplasty surgeon in general. I would highly recommend finding a well trained plastic surgeon who does rhinoplasty. You should see an actual plastic surgeon (trained in plastic surgery residency and ideally aesthetic plastic fellowship) who specializes in rhinoplasty. Best of luck.

Ryan Rebowe, MD · Answer

This will very much depend on the comfort level of the plastic surgeon that you consult with. Many plastic surgeons routinely do septoplasty procedures through a variety of techniques and incisions, while others perform mainly cosmetic rhinoplasty. I would be very direct in asking your plastic surgeon the best possible approach. In general, ENT's are adept at accessing a nasal septum through a variety of approaches. It may be possible for your plastic surgeon to coordinate with an ENT if possible to perform the septoplasty at the same time that your plastic surgeon performs the rhinoplasty to ensure an optimal functional and cosmetic result.

Andrew Miller, MD · Answer

The best doctor to go to in this situation is a surgeon that has extensive experience in rhinoplasty surgery and does them all the time. Anyone that does will do a good septoplasty at the same time. Plastic surgeons are well trained, but many of them do only a few rhinoplasty surgeries. Same goes for surgeons that are mainly ENT providers. Either one could do well, or a facial plastic surgeon could probably help you as well - but they need to do rhinoplasty all the time.

Ronald J. Edelson, MD · Answer

You really can’t make a generalization regarding which specialty to go to. There are many ENT and plastic surgeons that would be able to take care of you and there are those that don’t do this work often or at all.

Eric M. Joseph, MD · Answer

Our practice is Focused on both functional and cosmetic nasal surgery. My training is in ENT, And I completed a fellowship in facial plastic surgery over 20 years ago. Since our specialty tends to be dual certification, this would be my recommendation. Hope this helps! Dr Joseph.

Behrad Elmiyeh, MBBS, MRCS, FRCS (ORL HNS) · Answer

Thank you for your questions.
I would strongly advise you to see a help of an ENT/ nose specialtist (Rhinologist) with special interest in rhinoplasty. ENT surgeons peform setoplasty routinely and hence are more experienced than plastic surgeons who are mainly concerned in improving the aesthetic apperance of a nose.
The use of manipulated (morphed) digital clinical photography provides a platform for discussion as to your desires and expectations. Such images are not a guarantee of exact results, but a great tool to ensure that you and your surgeon are on the same wavelength.
Best wishes,

William Portuese, MD · Answer

A rhinoplasty is done for purely cosmetic purposes, while a septoplasty fixes a deviated nasal septum. Sleep apnea is multi factorial, not just from a deviated septum alone. Both a functional septoplasty and a cosmetic rhinoplasty can be performed simultaneously. Look for a double board certified ENT/facial plastic surgeon who can handle both components of the nose.

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