Would I benefit from Rhinoplasty at the same time as having my polyps are removed? (Photo)

I have a referral to see an ENT as I have been told I have a polyp. I have been suffering sinus problems my whole life but over the past few months it has got considerably worse. My snoring is really bad, my nose is constantly blocked/running and I don't have any sense of smell. I have always wanted to have a nose job, but would this be the right time to do both? What would be the advantages/disadvantages? Would I be better off seeing a plastic surgeon, ENT or someone trained in Otolaryngology?

Doctor Answers 3

Cosmetic rhinoplasty and functional endoscopic sinus surgery combination

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Polyps in the nose are removed with functional endoscopic sinus surgery. A CAT scan of the sinuses is required to make a determination about how many polyps are present, and in which sinuses they are located. A cosmetic rhinoplasty can accomplish reduction of the bulbous tip, shaving down a dorsal hump, narrowing the bridge. Both endoscopic sinus surgery and the rhinoplasty can be performed the same time under the same anesthetic with the same recovery period. To perform them simultaneously would require a seeking out a double board certified ENT facial plastic surgeon with extensive experience both procedures. For more information about both procedures, many diagrams and many before-and-after rhinoplasty result, please see the link and the video below

Probably not the right time to do both.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

See the "Web reference" link, just below my response. I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.

You have wide tip cartilages that make the tip look big. You didn't post a profile, but usually, wide tip cartilages like that will also make the tip look long, drooping down some, like in the woman in the short video I posted just above.

There are a few reasons that you probably shouldn't have both operations at the same time. If you had only one or two small polyps in your nose, they could be removed at the same time as the rhinoplasty, but if more extensive work is needed, you wouldn't want that work to interfere with the cosmetic portion of the operation, where pieces of millimeters are very important. If you needed work on your sinuses themselves, and not just on polyps inside the nose, then you certainly wouldn't want to have both done at the same time.

Then, you have an exquisitely difficult nose to correct, because of the complicated work that is needed on the tip cartilages. Most plastic surgeons would not be able to handle it with skill and some level of predictability, and the chances that your otolaryngologist who treats polyps and sinus disease can perform the operation are just vanishingly slim.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Your nose is also a good example of why computer imaging 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. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Nose shape and function

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for the question and photos.  There is no wrong or right answer to your question.  You could certainly have two surgeries to address both issues or have one surgery to take care of them both at the same time. The key will be to have someone that has experience with both and who can show you before and after photos of rhinoplasty surgery that you like and appreciate.  I always focus on both form and function every time I do a rhinoplasty since you want your nose to look and function as good as possible.  You may benefit from spreader grafts, septum work, and turbinate reduction as well at the same time as your polyp removal to maximize breathing and reduce snoring.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 170 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.