Should a deviated septum be corrected during rhinoplasty if there are no breathing issues?

Question

I have a deviated septum but no breathing issues. I feel that my nose has become more crooked over the last year or so an has developed a bump on the bridge. The surgeon who I just consulted with for rhinoplasty doesn't want to touch my septum and just wants to fix the nose cosmetically since I can breathe. To me, that seems like building a house on a foundation that isn't level. Do you think the septum needs to be fixed during the rhinoplasty so that it doesn't continue to get more deviated?

Richard W. Westreich, MD · Answer

If you have a deviated septum it should be fixed during rhinoplasty. There is no way to predict whether it will become a problem after making your nose smaller. Furthermore, if your nose is deviated, leaving the septum crooked will increase the likelihood of persistent deviation post operatively.

Samuel Lin, MD, FACS · Answer

It depends on a patient's examination of the nose on the inside as well regarding the degree of septal deviation and medical history- yes, septoplasty and rhinoplasty are often performed together and it is key to make sure the function of the nose remains good after nasal surgery..

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. It depends on how bad the septal deviation is and if your nose crooked also.  Even if you are not having breathing problems, your nose may be crooked and it would be a good idea to have a septoplasty at the same time.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. 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

Philip Solomon, MD, FRCS · Answer

The nasal septum is  a critical  structural component of the nose.  Even if you are not symptomatic from your deviated septum your surgeon should consider straightening it at the same time as rhinoplasty. A septoplasty  is often done to ensure you dont develop a breathing problem from the rhinoplasty procedure and to avoid any  adverse rhinoplasty outcome  such as a crooked nose.  In certain situations your nose can become more crooked post nasal hump removal if the nasal septum is not adequately straightened.

Mark Samaha, MD · Answer

This is an excellent question and one that is very frequent among patients seeking rhinoplasty. The answer, however,  is different for every patient. Firstly, everyone has a deviation in their septum. However, most are mild and non-symptomatic and therefore do not need surgery. There are two reasons to operate a deviated septum during rhinoplasty. 1- Symptoms of nasal obstruction attributable to an observed significant deviation and 2- a septal deviation that is thought to contribute to the appearance of a crooked nose (the nose is aesthetically shifted to the right or left of the middle). If neither of these is present, there is no need to operate the septal deviation. Since you are not having any symptoms, the remaining question then is does your septum contribute to your nose being crooked. That is seldom the case, but when it is, it is virtually impossible to significantly improve the crookedness without addressing the septum. The only way to evaluate that is an examination. Your surgeon could answer this. If you still have doubt, a second opinion by a surgeon experienced in septoplasty surgery would be helpful. Good luck.

William Portuese, MD · Answer

Everyone has some degree of septal deviation, but the degree of the deviation will determine whether not there's any symptomatic issues. A very mild the nasal septum should probably be left alone. A moderate to significant deviated septum should probably be repaired, since it will possibly cause nasal obstruction when the nose is made smaller.

Reza Momeni, MD, FACS · Answer

This is a very common and a very good question.  Unless the bony nasal vault narrowing that is planned is very significant, in my experience it's not necessary to fix a non-symptomatic septal deviation, but you have to be seen in person to really get proper recommendations. Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

Pedram Imani, FRACS, MS, MBBS (Hons) · Answer

I couldn't agree more with your analysis, well done.  It is vitally important to address the septum whilst doing a rhinoplasty.  The saying that "so goes the septum so goes the nose" is 100% true.  In order to be a specialist rhinoplasty surgeon, the surgeon needs to understand the nose in it entirety not just the aesthetics, or else the results will be suboptimal.  The septum is the foundation of the nose and you are very right in saying what you have said.  Facial plastic surgeons have generally be trained in ENT/Otolaryngology and then sub-specialise in facial plastic surgery, this gives them a unique insight into nasal surgery and rhinoplasty.  Find yourself an experienced facial plastic surgeon who would be able to address your nose properly.  Hope this is helpful.

Rick Rosen, MD · Answer

I would recommend you consider a second opinion. The presence of a mild deviation of the septum, does not mean it needs to be operated on. The Rhinoplasty will still give you a good result and not a crooked house. But if your septum deviation is significant then it should be fixed at the same time. Without symptoms or breathing issues, chances are you may not need the septum addressed. But if you do ( by examination), then this is the time to fix it. Good luck.

William B. Rosenblatt, MD · Answer

I have an ENT and Plastic surgery background, therefore I am comfortable fixing the inside and outside of a nose at the same time. Some plastic surgeons have little experience doing septums -- so they stay away from them. As your question can not be answered without seeing you, go for a second opinion.

Should a deviated septum be corrected during rhinoplasty if there are no breathing issues?

Answers (15)

More Rhinoplasty Questions

WE SEND PRETTY
EMAILS

Answers (15)

More Rhinoplasty Questions

I have low blood platelets and I want to get rhinoplasty done?

Can I get an indentation in the bridge of my nose fixed without a nose implant or open surgery? (Photos)

What did Gwen Stefani do to her nose bridge in your Professional opinion? Oesteotomies? Rhinoplasty? (Photos)

Go back to work after rhinoplasty and septoplasty?

Is it worth risking getting my bossae removed by external incision? What is the likelihood it will return? (photos)

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS