Septoplasty after 3rd rhinoplasty, possible collapse?

Question

Hi! I have had 3 rhinoplasties on my nose. I bumped my nose about a year ago, pretty hard after the 3rd. There was no blood, but 2 weeks later, I noticed a dent. I thought it was just scar tissue from the 3rd nose job. I went into an ENT recently and he said I have a deviated septum and wants to repair it. I want this as well, but I'm worried about how much more my nose can handle. Are there many complicated septoplasties like there are rhinoplasties, considering they don't break the nose?

William Marshall Guy, MD · Answer

Hello Dmq48,A septoplasty does carry the risk of collapse of the nasal dorsum.  This risk is minimized by leaving an appopriate amount of septum near the dorsum of the nose.  Given your three previous rhinoplasties, it makes your surgery more difficult surgically.  The reason is that the amount of cartilage that remains in your septum is variable.  This cartilage is frequently used as a donor cartilage for rhinoplasty.  Depending on what has been previously performed during your rhinoplasties, this may also increase your risk for collapse.  The key is to make sure you have a well trained surgeon.  Appropriate analysis of the nose ahead of time and using appropriate diligence during surgery can greatly reduce your risk of having a complication.  If you hare having difficulty breathing, then the septoplasty can help that, but there are the risks we stated above.  If you are not having any difficulty breathing, then the septoplasty would not help anything.  If there is a deviation causing obstruction and the deviation is down low, then there isn't much of a risk of having collapse.  If there is a deviation causing obstruction and it is up high, the septoplasty has a greater risk of causing collapse and maybe a spreader graft to open up that area would be a better option.  Finally, if you had any septal work during the previous procedures, it also increases the risk of having a septal perforation (although this risk still is low) with a septoplasty.  Given how much there is to consider for your septoplasty, even though a rhinoplasty is not being performed, it is important to choose an appropriate surgeon.  Yours may be fantastic, so discuss your concerns with him or her and get your surgeon's advice before proceeding.  You may even consider a second consult with a facial plastic surgeon or another ENT.  I hope this helps and good luck.

William Portuese, MD · Answer

A revision rhinoplasty is one of the most difficult procedures to  perform in the entire field of cosmetic surgery, so it's very important to make those decisions at the time of the examination and consultation. A deviated septum is diagnosed with an internal examination of the nose or a CT scan of the sinuses. A septoplasty and a rhinoplasty are  two completely separate operations, however both can be performed at the same time if needed. A rhinoplasty procedure is performed to improve the outside appearance of the nose such as straightening the nasal bones, and building up the dent with a cartilage graft. A septoplasty  is performed in the back of the nose when there is bone and cartilage blocking air flow. A septoplasty will not change the shape of the nose. In order to bill a septoplasty to the patient's medical insurance, medical necessity must be documented at the time of examination and consultation. Anticipate paying for the rhinoplasty component yourself, since it is cosmetic.

Javier Galindo, MD · Answer

Septoplasty is a common an easy procedure to improve your breathing. The septum is very important to overall nasal appearance, so in a patient with 3 previous rhinoplasties it can be severely damaged. I would recommend you trust an experienced nasal surgeon in but functional and cosmetic rhinoplasty to improve your breathing while not disturbing the appearance of your nose.

Septoplasty after 3rd rhinoplasty, possible collapse?

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