Will closed septoplasty fix my deviated septum? (Photos)

Question

I would prefer closed to open surgery as I have a keloid scar on my shoulder, and would not want to risk another one (especially on my face). My nose bends to my right side of my face and my cartilage is visible from a straight beneath angle. Will I have to ask for a cartilage skin graft to level out the nostrils appearance, as cartilage is visible and it makes my columella look wonky. Will the septoplasty correct the abnormal appearance of my nose? I was told it is a deviated septum, but will septoplasty fix the wonky appearance & stop what appears to be a collapsed structure? Is my columella wonky or is it just giving this appearance due to the un-aligned cartilage bone? Will closed surgery suffice the surgical requirements? (fix my nose)

Gary Linkov, MD · Answer

Rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations. Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.

In your situation, it does appear that your septum is deviated. A closed approach is usually enough to correct the issue.

Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible.

Gary Linkov, MD 
Rhinoplasty Specialist 
Manhattan

Lucian Ion, FRCS · Answer

If your concern is primarily related to the scar, it is important to appreciate that the columella, in the same as the eyelids, does not seem to produce scar hypertrophy let alone keloids.

For the contour of the nostrils, the first stage is to straighten the structural support of the septum and nasal bridge and then the structural support of the tip cartilages. This often improves the symmetry of the nostrils significantly. Additional changes and cartilage grafts would only be evaluated after their central structures have been addressed.

By and large, if you do not absolutely need grafts to the nostrils, it is better to avoid them as they bring their own volume to the area.

It is definitely worth having a conversation with both a surgeon that specialises in close interventions and while the specialises in open interventions to understand the approach differences and your options.

Edwin F. Williams, III, MD · Answer

A closed approach can fix your septal deformity. There are various manuevers that can help address the more caudal deviation - this could be considered a closed rhinoplasty. Regardless of how you phrase it, in the correct hands this could be corrected without having to "open the nose" or make an incision through the skin of the columella. I recommend that you seek consultation with a board-certified facial plastic surgeon to discuss these issues. There is differing of opinions among surgeons regarding their preference for closed or open surgery. I have done numerous cases both ways, and currently tend to perform more closed procedures as this leaves patients without the external scar and reduces healing time. Best of luck!

Behrad Elmiyeh, MBBS, MRCS, FRCS (ORL HNS) · Answer

Thank you for your questions and for sharing your photographs.

Rhinoplasty is frequently performed in combination with Septoplasty (called Septorhinoplasty) to correct a deviated nasal septum (the cartilage in the nose that separates the nostrils) causing a blocked nose and/or to harvest septal cartilage and use it as a graft to improve nasal support or shape.

You will surely require having a Septorhinoplasty.  Of course ideally surgeon would like to perform a closed Septorhinoplasty as long as a good result is likely with this approach. If your nasal septum has significant deviation, an open (external) approach can provide a better visualisation of intricate  internal nasal anatomy and hence a better outcome.

I would suggest that you consult with a nasal surgeon (Rhinologist) with expertise in performing complex rhinoplasty.

You should expect a full detailed examination of your nose is required to assess your nasal skin, cartilage, bony structures, and your nasal airway/ breathing. This will allow the surgeon to evaluate your nasal appearance and its relation to your facial features.

The use of manipulated (morphed) digital clinical photography provides a platform for discussion as to your desires and expectations. Such images are not a guarantee of exact results, but a great tool to ensure that you and your surgeon are on the same wavelength.

Only after full discussion about risks vs benefits of closed vs open Septorhinoplasty based on the examination findings you can make an informed decision about your surgery.

Best wishes,

Jeethendra Rao, MBChB, FRCS(OMFS), MFDS · Answer

Your nose bending to the right appears to be as a result of a deviated septum. This can be seen in the left nostril as it is likely dislocated from its position. A septoplasty, which majority are done closed could correct this. With such a bend in the septum it is likely you will have partial blockage of airflow on one side and this could be improved with a septoplasty. Depending on the quality of your cartilage you may or may not need the cartilage remodelling or additional grafts.

Will closed septoplasty fix my deviated septum? (Photos)

Answers (8)

Answer: Rhinoplasty

Answer: Rhinoplasty

Answer: Closed Septoplasty

Answer: Closed Septoplasty

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Everything you need to know about Rhinoplasty

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Will closed septoplasty fix my deviated septum? (Photos)

Answers (8)

Answer: Rhinoplasty

Answer: Rhinoplasty

Answer: Closed Septoplasty

Answer: Closed Septoplasty

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.