Should I do the septoplasty or not? (Photo)

Question

I have a severely deviated septum for which my ENT recommended a septoplasty. However, he mentioned that because I had a rhinoplasty (9 years ago) I could risk dropping my tip. As you can see, the tip didn’t help perfectly. It became more bulbous than before. Will the ENT fix it as a part of the procedure to correct the septum? I’m really hesitant and I need an advice. Thank you

Steven M. Denenberg, MD · Answer

While it's true that a septoplasty typically doesn't change the appearance of the nose, if your surgeon thinks he will harm the appearance of the nose by performing a septoplasty, then you shouldn't have the operation! It's really that simple.Then, you mention that the tip is more bulbous than before your rhinoplasty. There are a couple other issues that I see as well, just based on these limited photos: there is an irregularity along the bridge of the nose, and to my eye, the tip of your nose sits lower than I'd like to see it. Elevating the tip a bit might be a good idea as well.The woman in the short video that I posted with this answer had the tip of her nose narrowed and shortened in her revision operation.But no, the ENT won't "fix it as part of the procedure." Nothing happens unless you are carefully counseled as to what the plan is, and what you want. And the changes I outlined require quite a bit of expertise in revision rhinoplasty, something the typical ENT, and even the typical plastic surgeon, doesn't possess.If you want to consider changing the appearance of your nose, you need a careful revision rhinoplasty evaluation. How *much* to elevate the tip, or deproject the nose? 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 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 always 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 only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember also 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. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging by the operating surgeon is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?Finally, if you are considering a revision, you should not have a preliminary operation where just the septum is fixed. If you eventually have a revision, the septum should be done by the revision surgeon. If a different surgeon just fixes the septum first, he might do something that will make the revision more difficult.Whew! Hope I didn't confuse you!

Ronald J. Edelson, MD · Answer

A septoplasty will have no affect on the appearance of the nose and should not cause it to droop. In fact it would be quite simple to raise the tip at the same time as septoplasty if you wished.

William Portuese, MD · Answer

A septoplasty does not change the shape of the nose, and is performed only to improve airflow dynamics through the nose.  A septoplasty is performed internally in the back of the nose for a deviated septum blocking airflow. A  Rhinoplasty is performed to change the shape of the nose. Both procedures can be performed together if necessary. A properly performed septoplasty should not drop the nasal tip.

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