Will a crooked nose cause a deviated septum to reoccur? (Photos)

Question

I recently saw an ENT, who confirmed I had a substantial deviated septum which has caused dry throat, nose bleeds, etc.. As you can see by my pictures, I have a lot going on with my nose. My question is this: if I have the septoplasty, but nothing else done to my nose, can the septum become deviated again because my nose is crooked? It seems the older I get, the more my nose twists. If this is the case, I will consider plastic surgery to correct the twisted nose or whatever necessary.

Callum Faris, MD · Answer

Thank you for your question it highlights an important question on terminology.
Rhinoplasty is primarily aim at cosmetic changes to the external appearance of the nose. It is where the nasal bones of the nose are broken and re-set with or without a hump reduction or changes to the nasal tip cartilages.
Septoplasty is where the cartilaginous septum (the partition in the middle of the nose dividing it into two nostrils/nasal cavities) is addressed to make it straight. The nasal bones are left alone. Most people mean septoplasty to small surgeries within the nose where the external appearance of the nose does not change.
Straight nose + Deviated septum + nasal obstruction = the majority of these cases of nasal obstruction can all be dealt with by a Septoplasty alone. 
Deviated nose + Deviated septum + nasal obstruction = only some of these cases of nasal obstruction can be address adequately with a Septoplasty alone.
Septorhinoplasty, this is where the septum and external shape of the nose are both addressed at the same time. The majority of nasal surgeries are of this type.
Deviated nose + Deviated septum + nasal obstruction = In many of these cases of nasal obstruction the external nose deviation contributes to the obstruction. In these instances it is important to address both the deviated septum and external nasal deviation at the same time. This would require a Septorhinoplasty.
Postoperative changes:
Small changes in external appearance can occur over the post-op healing phase of 6-12 months. Following this the nose should be relatively stable in scar tissue. 
The answer to your question can only be known after examining the inside of your nose and making a correct diagnosis. Both types of surgery can lead to recurrent nasal obstruction, although in my experience, the relapse rate after Septorhinoplasty is less than that for Septoplasty. I hope this helps.

Howard Stupak, MD · Answer

Hi Lauren73
You do have a deviated nose and septum, but your main problem is something called the Tension Nose Deformity.  This requires a rhinoplasty procedure to fix, and simple septoplasty will be completely inadequate for you.  You need to have rhinoplasty to address this over-sized septal cartilage.  Then, you can return to being a nose breather at night, and will have your sleep symptoms like dry mouth and bleeding nostrils restored.  Only a very specific type of rhinoplasty addresses these problems.

Stephen E. Metzinger, MD · Answer

Dear Lauren73:      It is more likely that the nasal septum deviation is causing part of the crooked nose. Remember "as the septum goes so goes the nose." I recommend consultation with a board certified plastic surgeon or facial plastic surgeon with rhinoplasty experience. The Rhinoplasty Society is a good place to start. Good luck and I hope this helps!

Jeremy B. White, MD · Answer

Your nose may be crooked partially because of your deviated septum, but fixing the septum alone will not usually fix the crooked nose problems. This often requires placement of grafts to straighten the dorsal septum edge, often while shaving down areas of crookedness. Fixing your deviated septum should not make your nose appear more crooked usually, unless a significant problem occurs with this surgery.

William Portuese, MD · Answer

A deviated septum  and a crooked nose  are two completely separate issues. A septoplasty is performed in the back of the nose to improve airflow dynamics when there is a significant deviated septum present and medical necessity has been documented. A rhinoplasty procedure is performed on the external structures of the nose to shave down the dorsal hump, narrow the tip and straighten the bridge line, and is considered cosmetic must be paid for by the patient. Both procedures can be performed together when necessary, which allows one anesthesia and one recovery period. For more information about the differences between rhinoplasty and septoplasty, please see the video below

David A. Sieber, MD, FACS · Answer

Thanks for the great question! For a plan septoplasty, the deviated portion of your septum is removed, but it won't have any effect on how straight your nose is. Removing the deviated portion of the septum should not further twist your nose over time. If you don't like the appearance of your nose and are having difficulty breathing, then I would recommend having a septoplasty and rhinoplasty at the same time to correct your breathing and the cosmetic concerns for your nose. Best of luck!~Dr. Sieber

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