ENT vs. facial plastic surgeon for saddle nose deformity? (photo)

Question

2018 I had my deviated septum repaired. I now have a major saddle nose deformity. My ENT can fix it. I’ve seen two facial plastic surgeons and they are charging “cosmetic fees” even though my insurance has approved the cpt and surgery codes for a rib graft. And what are the pros and cons of the ENT and facial plastic surgeon preforming the surgery? First pic is 2017 pre surgery. second is 2019 post surgery

Eric M. Joseph, MD · Answer

If the breathing through your nose is good, you may not need additional surgery. Permanent nonsurgical rhinoplastic treatments with microdroplet Silikon1000 may be considered for achieving a straighter nasal profile without the inconvenience of additional surgery. Another approach may be to consider an onlay graft like ePTFE (GoreTex) - that would preclude harvesting your rib.
If you have your heart set  on rib reconstruction, consider using the surgeon with the most experience harvesting rib, and using it for reconstruction. Look at photos of similar cases before choosing your surgeon. Hope this helps. Dr Joseph PS - nearly all FPSs are also trained in ENT...

Samuel Lin, MD, FACS · Answer

Depending on insurance and history this treatment of saddle nose may or may not be covered... It is important to have your rhinoplasty surgeon be well trained and perform nasal surgery routinely with regards to preserving function of the nose as well..

William Portuese, MD · Answer

This is a rather severe complication from your septoplasty procedure.  A thorough internal and external examination of the nose is going to be required to make a determination about how best to proceed.  Unfortunately, you probably do not have any cartilage left on the inside of the nose for potential grafting purposes.  This would have to be determined on examination.  Nasal cartilage is the primary grafting source for a nose deformity.  Ear cartilage can be used as a graft if there is no cartilage left on the inside of the nose.  Rib cartilage can also be used,  but would not be the first choice.   A reconstructive rhinoplasty such as this is a very difficult endeavor, so it is imperative that you  choose a surgeon wisely based on extensive experience

John Frederick, MD · Answer

Hi and thank you for your question and photos,
In general, I would recommend a fellowship trained facial plastic surgeon with experience in revision rhinoplasty / repair of saddle nose deformity.  This surgery is complex and, if not done properly, will require revision. With each revision, the surgery becomes more complex, more unpredictable, and with a longer recovery process.  While some ENT surgeons who are not fellowship trained in facial plastics surgery may be technically capable of performing the surgery, their results may not be acceptable and they likely do not perform this type of surgery on a regular basis (if ever).
I hope this helps and with you the best of luck.
John Frederick

Richard W. Fleming, MD (retired) · Answer

I believe in specialization so either a board certified facial plastic surgeon or an ENT who is experienced in nasal revision surgery would be a good choice. Ask to see multiple examples of other patients who had a similar problem.

Michael Elam, MD (retired) · Answer

You will need a surgeon who has expertise in both the function and aesthetics of the nose. Whether this is your ENT or the facial plastic surgeons you have seen should be determined on their expertise in revision rhinoplasty surgery. Best regards, Michael V. Elam, M.D.

ENT vs. facial plastic surgeon for saddle nose deformity? (photo)

Answers (6)

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