8 months after revision rhinoplasty and deviated septum has returned - what could have caused this?

Hello and thank you for your question.

To summarize, it seems you had a functional rhinoplasty surgery a few years ago that improved your breathing, and then a cosmetic rhinoplasty 8 months ago that has now compromised your breathing with potentially re-deviating your septum and causing snoring. If this is the case, I would recommend obtaining a complete exam of your nasal airway, throat, tonsils, tongue, etc to fully evaluate your nasal breathing/snoring. An ENT can perform a complete intranasal exam (with insertion of a camera, etc) -- potentially the original surgeon you had from a few years ago.

Once a definitive diagnosis is found, the next steps will be clearer.
- If the septum was re-deviated, then a revision septoplasty can be performed.
- If you have internal nasal valve collapse, then spreader grafts might be necessary.
- If external nasal valve collapse is present, further cartilage grafting at the tip may be necessary such as lateral crural stuts, possible alar contour grafts, possible columellar strut graft, etc.
- If your turbinates are hypertrophied, they may need to be resected.
- If the back of the throat and tongue are involved in the breathing difficulty, they may need to be addressed.

As you can see, there are a number of issues that need to be explored, but I am confident that if you address these systematically with your current surgeon (and potentially your prior ENT as well), you will get better.

Please recognize that complications happen to every surgeon. The important thing is to move forward, have an organized plan, and take steps to getting better.

Hope this helps. For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Thank you for sharing the details of your experience and concerns following your revision rhinoplasty. It can be frustrating to encounter functional issues after undergoing multiple procedures.
In some cases, despite a successful aesthetic revision, the nasal structure may still be vulnerable to changes over time. Factors such as scar tissue formation, healing responses, or the natural anatomy of your nasal passages can occasionally lead to the recurrence of issues like a deviated septum. While surgeons strive to achieve both functional and aesthetic goals, the healing process and anatomical complexities can sometimes yield unexpected outcomes, including a return of symptoms such as snoring or breathing difficulties.
It is recommended to discuss your concerns directly with your surgeon, as they can provide a thorough examination and advise on the potential causes and next steps. Depending on your specific case, there may be additional options available to address these concerns.

Hello and thank you for your question. There are many factors that contribute to this. It is very important to properly provide structural support to the septum when performing this surgery. This could likely be corrected during a revision. With good surgical technique, you could likely 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