Deviated septum 5 years after septorhinoplasty? (Photo)

Question

Hi there, I had a septoplasty/rhinoplasty/turbinate reduction in 2019. While my nose is better than my original nose, I am still having problems. I do not breathe as well out of my right nostril. I also get these painful sores on the inside of my right nostril about every other month. There is a bump on my nose but only visible from one side. My nostrils are uneven as well. I guess I just want a doctor's opinion through these photos with what they think.

Gianfranco Frojo, MD · Answer

It is difficult to tell what is going on without a worm's eye or helicopter view. Problems breathing after a rhinoplasty can be due to persistent nasal valve obstruction or newly created weakness/obstruction. Usually the best option is a revision rhinoplasty to fix the entire nose from inside out. Sometimes the painful sores inside are from permanent sutures that are working themselves out or can already be eroding through the tissues. There are other reasons for this, but that tends to be the most common. I would recommend finding an American Board of Plastic Surgery certified surgeon with extensive experience in revision rhinoplasty.

Oakley Smith, MD, FRCSC · Answer

Hi, It is better for you to consult with your facial plastic surgeon who can examine you and give you opinion based on examination. Revision surgery would be a valid option to fix breathing, crookedness, and remove the hump.

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have a wide nasal appearance, along with an overprojected droopy tip, and a dorsal hump. If this is associated with breathing difficulties, a rhinoplasty specialist should be able to shed light on what might be best for you to move forward, so you could have a less distracting nasal appearance, and a better breathing nose.

Steven M. Denenberg, MD · Answer

It's great that the nose is better than it was before surgery, but, and no offense intended, I don't think it was a particularly excellent rhinoplasty. I would have taken the bridge down more, narrowed the tip and bridge more, elevated the tip more, and brought the tip and bridge and entire nose back closer to your face, so the tip didn't project as far forward.

The good news is that these are all changes that are fairly predictable to accomplish, even in a revision, but only in expert hands. You have to be very careful about your selection of surgeon for your revision if you decide to go that route; not very many rhinoplasty doctors would be able to handle your case with expertise.

Stephen Prendiville, MD · Answer

I can only comment on the aesthetics of your nose virtually, which would most likely benefit from a well performed revision rhinoplasty.  Since you have had a previous septoplasty, an alternate source of cartilage may have to be used.  This will usually be from your ear (conchal cartilage).  The dorsal hump reduction is usually straight forward in experienced hands; a revision can make your nose straight-er, but making it perfectly straight may not be achievable.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. This can also be designed to help improve your breathing. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

William Portuese, MD · Answer

To make the diagnosis of a deviated septum is going to require an in-person examination to document medical necessity and obtain prior authorization with your medical insurance. A revision rhinoplasty can accomplish shaving down the dorsal hump, refining your nasal tip, along with narrowing and straightening your bridge line. A closed rhinoplasty approach can accomplish this with all the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required either. Revision rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so choose your revision surgeon wisely based on extensive experience. Look for a double board-certified ENT/Facial Plastic Surgeon with a large photo gallery of before and after rhinoplasty results that look natural

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