Am I candidate for septoplasty and rhinoplasty? What type of surgeon should I see? (photo)

Question

I would like have a septoplasty and minimal rhinoplasty combined. What type of surgeon should I see? Based on the CT, would insurance pay for this? I do have restricted airflow on the left. My nostril collapses when breathing solely from that side. Thanks in advance!

Andac Aykan, MD · Answer

Hello,‍‌‍‍‌‍‌‍‍‌ thank you for the pictures. 
Indeed, septoplasty along with a conservative rhinoplasty seems suitable for you. Your airflow problem and the collapse of the nostril can be fixed at the same time along with minor cosmetic refinement. It is very clear from this axial slice that the septum is deviated and one nasal passage is significantly narrowed. The asymmetry indicates that the obstruction is a structural one. You also said that the nostril collapses when you are breathing, which might be the internal nasal valve weakness. These results correspond to functional breathing problems which are corrected by septoplasty and, if necessary, valve repair. 
The most proper type of surgeon to do this is a facial plastic surgeon or an ENT surgeon who regularly does functional rhinoplasty. Both are equally good as long as you pick someone who is skilled with both breathing correction and aesthetic work in the same operation. 
Regarding insurance, the majority of surgeons send the breathing-related findings (e.g. nasal obstruction, valve collapse, septal deviation) for insurance approval, and you would probably be allowed to pay only for the cosmetic portion. They don't cover cosmetic changes. 
Andaç Aykan, MD, Assoc. ‍‌‍‍‌‍‌‍‍‌Prof.

Donald Groves, MD · Answer

Hello and thank you for your question and the pictures. Addressing breathing issues is actually one of the most common reasons people seek out and undergo a rhinoplasty. An open septorhinoplasty can best address both your functional issues and your aesthetic concerns with your nose- I'd also recommend nasal tip deprojection to improve the overall harmony of your different facial features. I would be able to address your septum, and open up and reinforce your internal and external nasal valves to improve the airflow through your nose! I'd also be able to adjust the size, shape, and definition of your nose.

This truly a surgery of millimeters- and whether you're looking for a minor adjustment or a major transformation, it requires exceptional surgical skill to achieve functional and natural-looking results! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading rhinoplasty experts (who performs 1,000+ nosejobs annually).

I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can understand from your question The most important thing you should pay attention to when choosing a doctor is that your doctor is a specialist in the field of Ent and a specialist in the field of facial plastic surgery is very important in terms of not having breathing problems in the future.
It would be better face to face consultation.
Best Regards!

Andrew Miller, MD · Answer

Based on your photos, you are a great candidate for rhinoplasty. The nose could be made shorter and better defined at the tip. At the same time, a septoplasty can be done to help breathing. The septoplasty can be covered by insurance, but the rhinoplasty would be a cosmetic procedure. Be sure to see a rhinoplasty expert for consultation.

Anya Costeloe, DO · Answer

Hi, and thank you for your question. For a combined septoplasty and rhinoplasty, you should see a board-certified otolaryngologist (ENT specialist) with facial plastic surgery training or a facial plastic surgeon who has experience in both functional and cosmetic nasal surgeries. These specialists are well-equipped to address both the structural and aesthetic concerns of your nose.
Regarding insurance coverage, septoplasty is often covered by insurance if it is deemed medically necessary to improve breathing or correct a deviated septum. Based on your base view photo, it looks like you have a deviated septum and valve collapse on the left. The fact that you have restricted airflow and nostril collapse when breathing from the left side could support the medical necessity of the septoplasty as well as nasal valve surgery. It is important to have a thorough evaluation by the surgeon, who can document the functional issues and provide the necessary information to your insurance company.
Rhinoplasty, when performed solely for cosmetic reasons, is typically not covered by insurance. However, if there is a functional component addressed during the rhinoplasty in conjunction with the septoplasty, some aspects might be covered. It is advisable to discuss this with your surgeon and your insurance provider to understand what portions of the procedure may be covered and what your out-of-pocket costs might be. Best of luck!

John Michael Thomassen, MD · Answer

You may be fine with just a septoplasty.  This would improve your airflow on the side of the septal deviation.  Otherwise, your nose looks nice.  What changes would you like to make to the nasal appearance?

Steven M. Denenberg, MD · Answer

You didn't mention just what you'd want to change about your nose. What I notice is that the tip sits a bit low, making the nose look longer than you might like it. Also, the tip sits forward, away from your face. Left to me, I'd elevate your tip, and bring it closer to your face, and then lower the bridge to match the new position of the tip. You have that irregularity on the base view that could probably be improved some. Working on a septum at the same time as making cosmetic corrections is quite common.
How *much* to elevate the tip, or deproject the nose, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery.

Gary M. Horndeski, MD · Answer

You are a candidate for a septoplasty and rhinoplasty.  Your septum is deviated.  However, insurance may pay for the septoplasty but will not pay for cosmetic rhinoplasty.

Best Wishes,

Gary Horndeski, M.D.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a rhinoplasty and septoplasty. These can safely be combined in the same procedure. If you have a deviated septum with breathing problems, then insurance can cover the functional aspect of your surgery, but never the cosmetic aspect. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers.. With good surgical technique, you could 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

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Gianfranco Frojo, MD · Answer

It is very challenging to have insurance cover rhinoseptoplasty. Depending on your insurance carrier, they usually have a very strict set of guidelines that each patient case much meet. In my experience, they usually still deny these claims even when meeting each single step very clearly/properly. I would say the easiest option is to find a highly-trained American Board of Plastic Surgery certified surgeon with extensive experience in rhinoplasty.

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