Could my septum be deviated? (photo)

Question

Hello all! I have questions regarding my nose. I feel like I might have a deviated septum because I have trouble breathing (I have to flare my nostrils to breathe somewhat clearly) and I sneeze very often and multiple times in a row at that. My nose does not even remotely resemble that of anybody in my family.I guess I just want to know if you think it might be fixable. Also, can septoplasty be covered by insurance while also improving the appearance?

Thomas J. Walker, MD, FACS · Answer

Thank you for your question. I recommend you see a rhinoplasty expert for a consultation. Make sure the rhinoplasty surgeon also performs septoplasties routinely as part of the rhinoplasty (not all surgeons do!). He or she also needs to perform a nasal endoscopy during your initial consultation. Most patients have a deviated septum to some extent but nasal obstruction is not necessarily related to the deviated septum; or at least the deviated septum is often not the primary cause of nasal obstruction. In other words, just because there is a deviated septum does not mean that the deviated septum is the primary cause of nasal obstruction. Oftentimes, there is external or/and internal nasal valve collapse, which may be the primary cause of nasal blockage and hence needs to be addressed through appropriate cartilage grafts. Based on your description I suspect that you have at least some nasal valve collapse given your improvement of nasal breathing when flaring your nostrils (called the "Cottle maneuver"). If breathe right strips or pulling your cheeks sideways improve your nasal breathing meaningfully, chances are you need more than just a septoplasty. I advise that you seek a consultation with a board-certified facial plastic surgeon (or general plastic surgeon who performs septoplasties - not everyone does), who sepcializes in rhinoplasty and who not only performs primary rhinoplasty but also a significant number of revision surgeries. Regarding insurance coverage, most insurances cover the septoplasty portion of the procedure, and some also cover nasal valve repair. Good luck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.   Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their
results.   The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Andre Aboolian, MD · Answer

From the photos you have provided it seems like you have a deviated septum; however, you need to be examined in person, specially if you are having problem breathing.  You should seek consultation with a board certified plastic surgeon and in choosing one you should review the before/after photos to see if you like the results (make sure they show you three views from each patient - front, quarter turn and profile.

Steven Wallach, MD · Answer

An exam in person is what you need to have done. I see some issues with your nose, but the exam in person is key.

Jeffrey Jumaily, MD · Answer

You may have a deviated septum based on these photos. If your nose is blocked and congested, and you have maximized medical therapy such as saline rinses and nasal steroids then septoplasty may be a good option for you. Depending on where the deviation is, the surgical approach differs. Generally speaking insurance does not cover cosmetic surgery. Straightening your septum may straighten your nose but will not change the shape. Good luck.

William Portuese, MD · Answer

The only way to document a deviated nasal septum is by a thorough internal examination of the nose by a rhinoplasty and septoplasty specialist. There are many issues on the inside of the nose that can cause breathing issues. A deviated septum can block airflow through the nose. A septoplasty is performed to improve airflow dynamics through the nose and will have no bearing on the shape of it. A cosmetic rhinoplasty changes the shape of the nose, and must be paid for by the patient, not medical insurance. For more information about the differences between a rhinoplasty and a septoplasty, please see the link and the video below

Victor Chung, MD · Answer

Septoplasty is a procedure to straighten the middle wall between your nostrils.

A deviated septum can disrupt breathing on both sides of your nostril. It's important to evaluate the entire septum as there can be deviation in the back of the nose too. There can be other factors affecting your breathing. I recommend a consultation with an ENT trained facial plastic surgeon who understands both the functional breathing (insurance covered) and the aesthetic improvement (not covered by insurance). Safety comes first.

Richard W. Fleming, MD (retired) · Answer

Although you do have some asymmetry of your nostrils which may be secondary to septal deviation which can cause breathing obstruction  you need to be examined by a rhinoplasty surgeon to diagnose the reason for your nasal breathing problems. Most health insurance companies will pay for correction of functional problems within the limits of the patient's policy. My staff will help our patients clarify their insurance benefits.

Paul Loewenstein (retired) · Answer

It does look like you have a deviated septum. Insofar as that interferes with your breathing, fixing that will be covered by insurance.  Anything that is done just to improve your appearance would not be covered. In our office we have the ability to tell the patient exactly what they would be responsible for and they can plan for that. All of this depends on the examination. On some occasions it can all be covered. That is best determined by your plastic surgeon.

James Fernau, MD, FACS - Account Suspended · Answer

Thank you for your question and photographs.I would recommend that you schedule a consultation with a board certified plastic surgeon who specializes in nasal surgery to have a nasal examination done and an accurate suggestion on how to correct the problems you are having breathing and with the appearance etc. You may benefit from a septorhinoplasty considering you are having trouble with your breathing and may have a deviated septum. Anything that is medically necessary can be put through your insurance to see if they will cover it. Anything cosmetic (external) such as straightening your nose, removing humps etc will have to be self-paid, most practices will offer payment plans for this. Best of luck in your endeavors.

Sincerely,

James Fernau, MD, FACSBoard Certified ENTBoard Certified Plastic SurgeryMember of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

Sincerely,

James Fernau, MD, FACSBoard Certified ENTBoard Certified Plastic SurgeryMember of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

Could my septum be deviated? (photo)

Answers (10)

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