I am 19 and had an altercation. I was punched on the side of my face and he broke my nose. My nose is deformed. It looks like I have a deviated septum. My question is whether this would be fixed in the doctor's office or it would be fixed surgically. The reason why I am asking is if I need surgery if at the same time the surgeon would be willing to make some slight changes to my nose by removing small bump and narrowing my nose a little.
How is a Broken Nose with Deviated Septum Fixed?
Doctor Answers 8
Borken nose with a deviated septum
It seems that you are a good candidate for a corrective rhinoplasty that will improve the way your nose looks to complement your facial features in a natural fashion. Generally, the approach of such a surgery will be performed in a surgical center. However, without a physical examination it is not possible to provide you with specific details. I highly recommend that you schedule a consultation with a well-experienced surgeon.
It is important to mention that the finest cosmetic results in any particular case are based on a variety of factors, including: the unique anatomy of the patient, realistic expectations, a well-informed and detailed discussion with your plastic surgeon concerning the best options for you especially covering a deep understanding of the pros and cons of any given choice you will adopt.
Please keep in mind that following the advice from a surgeon online who offers to tell you what to do without a physical examination covering the nature and the status of the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative solution would not be in your best interest. With that in mind, it is the safest and for your best interest to find a plastic surgeon with solid experience and certified by the American Board of Plastic Surgery who is ideally a member of the American Society of Plastic Surgeons that you will trust and be comfortable with. You should discuss your concerns with that surgeon in person.
Ali Sajjadian, MD FACS
Correcting a broken nose and deviated septum requires surgery
With regards to the broken nose, it is most likely that the nose is twisted on the outside as well as the inside. Both have to be reset back to the normal anatomical straight position so that the nose looks straight from the outside and breathes well from the inside. This type of surgery is not done in the office. This is done under a general anesthetic as an outpatient procedure in an ambulatory surgery center. This is fixed surgically. Occasionally, some cartilage grafting, such as spreader grafts are used on the concave inward side to bolster the cartilage, which is frequently fractured off the nasal bone. Cosmetic changes can be done at this time if the patient wishes to do so.
Fixing a Broken Nose
Fixing the broken nose and making any other changes can and should be done at the same time. Why have two separate operations? Many surgeons have an accredited outpatient surgical facility in their offices; therefore the procedure frequently done in the office, avoiding hospitalization.
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Timing of broken nose repair is variable
The textbook answer here is that you have roughly 10 days to "set" the nasal bone fracture, but any remaining septal deflection would be corrected by a septoplasty procedure about 3 months later.
The reason for the septoplasty delay is 3-fold: First, the septum might correct when the nasal bones are set, thereby obviating the need for a septoplasty. Second, some of the obstruction you are experiencing is likely caused by swelling and when the swelling resolves you may breathe fine. And third, if the nasal bones don't correct adequately, a rhinoplasty is usually recommended at 3 months, and any persistent septal deflection is corrected with the nose (septorhinoplasty). So waiting about 3 months for the septoplasty (and the rhinoplasty) is strongly recommended.
Can cosmetic changes be done to a nose when fixing a deviated septum?
It is important to know how long ago your altercation was. If it has only been a few days since the injury, you can have your bones set with some sedation. Then, after that has healed, you will need a surgical procedure to correct your cosmetic needs. On the other hand, if this is an older injury and the bones have already set, then it is possible to do it all at the same time. If your insurance company will pay for the deviated septum repair, then the cosmetic portion is usually an added cost for you. At least, that's how it is in the US. Good luck.
Nasal Fracture with Deviated Nasal Septum
You can have someone hit you from the other side, or if you prefer, the bones can be reset in a rhinoplasty surgeon's office.
With an acute nasal fracture, it is best to get the bones reset (closed reduction of nasal fracture) within the first 10 days, up to 18 days, but the longer that you wait, the more difficult it is to reset the bones. Usually best to wait at least 5 days after the fracture to allow all swelling to go down.
If your breathing is affected by a newly deviated septum, then that can be repaired along with "some slight cosmetic changes" to your nose at the same time in an operating room setting. It is best to wait a few months to allow all swelling and healing of the trauma to resolve before having this surgery. After a few months you may find that your breathing if fine, and that your external is fine. If not, then have the operation. The revision surgery rate is a bit higher in those who have their surgery too soon after their trauma.
Good luck and be well.
Both can be done at the same time.
After a few weeks the surgeon can do both since he has to rebreak the bones to center them. If there are other things you want done such as narrowing the tip, etc. they can also be done.
How Long ago was the latercation?
How long ago was the altercation? That is the key to this answer. If your nose was broken within the last few days then a closed reduction should be done in the office under sedation in order to straighten the bones. The septum should be allowed to heal and then secondary surgery can be done in a couple of months when all of the swelling resolves. Otherwise doing septal surgery on a recently fractured nose can be problematic in many ways. As far as modifications of the bridge of the nose I would be very cautious with this as well until at least 2-3 months following the fracture!