Should I See A ENT or Plastic Surgeon First?

I agree with Dr. Fleming's advice about who you could possibly consult with. The key is to find a specialist with alot of rhinoplasty experience. Typically, the portion of your surgery to improve your breathing will be covered by your insurance but this depends entirely on your carrier and coverage. The portion of the surgery devoted to changing the shape of your nose would be cosmetic and an out-of-pocket cost to you. I hope this information is helpful.
Stephen Weber, M.D., F.A.C.S.Weber Facial Plastic Surgery

Both ENT Otolaryngologists and Plastic Surgeons are trained to do rhinoplasty. However, there are a select few in each specialty that have significant expertise and experience in rhinoplasty. Therefore, do your homework carefully as rhinoplasty is the most challenging operation that we perform in aesthetic plastic surgery.

A Facial Plastic Surgeon is a plastic surgeon that focuses only on the face.  Most of the time they are trained in ENT first and are board certified in both ENT and Facial Plastic Surgery.  This training is optimal to think about nasal surgery not only from a cosmetic or "functional" rhinoplasty perspective, but also evaluate you for possible sinus disease, nasal polyps or any other cause of nasal obstruction.  Each insurance plan differs in what and how much of each procedure that they cover, but most plans will cover functional surgery despite the type of surgeon.

 A board certified Facial Plastic Surgeon must be board certified in Ear Nose and Throat Surgery prior to getting their boards in facial plastic surgery.  Look for a very  experienced rhinoplasty surgeon who can address functional and cosmetic issues at the same time. A septoplasty his performed for medical necessity  and is billed to the patient's insurance. Cosmetic  rhinoplasty is paid for by the patient themselves, and both surgeries can be performed at the same time

As a Facial Plastic Surgeon, ie an ENT surgeon who specializes in reconstructive, functional and cosmetic surgery of the face and neck, clearly I am biased.  That is why I chose the training that I did. ENT training enables a surgeon to handle the functional and cosmetic aspects of your surgery, but not all ENT surgeons practice cosmetic surgery.  Some general plastic surgeons have excellent training in nasal function, but I think a surgeon who has trained more specifically in surgery for nasal function and sinus diseases has a different understanding of the anatomy of the nose and nasal cavity and has a more extensive understanding of how the nose works. Nasal function is not just about a deviated nasal septum.  The surgeon also needs to be able to deal with nasal valve function issues and allergies.  That said, it is also an issue of experience and emphasis of practice.  There are some general plastic surgeons in the US with very extensive experience who have a very solid understanding of nasal function and how to optimize it. I can name a few.  Also, not all ENT surgeons emphasize facial plastic surgery and rhinoplasty in their practices; and I have many general plastic surgery friends who do not do rhinoplasty.  You need to pick your surgeon carefully.  Experience is equally as important as training.

Your insurance question should be straight forward.  If you have difficulty breathing through your nose, most insurance companies will cover the functional surgery according to their own guidelines and coverage limits.  They will not cover the cosmetic work or the anesthesia and day surgery expenses associated with the cosmetic work. 

I hope this explanation helps.  I tried to be as even handed as possible. 

Most modern training programs in both ENT and Plastic Surgery qualify surgeons who can do both cosmetic and functional rhinoplasty and insurance companies do not discriminate. See a few doctors and ask your surgical consultants about their personal experience with the problems you have and choose one that has been doing these surgeries for a long time and expect to pay a premium price for their expertise.

You can see an ENT who does rhinoplasty surgery, a facial plastic surgeon who does both functional and cosmetic work, or a plastic surgeon who is experienced in nasal surgery. There is no need to see 2 surgeons. The specialist you see will not influence your insurance coverage.