Should I See A ENT or Plastic Surgeon First?

 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.