Septoplasty to correct breathing problems
Septoplasty is only one of many surgical modalities to correct breathing problems. There are many other proceedures such as spreader grafts, turbinoplasties and other anatomical corrections which can improve nasal airway dynamics.
An in depth consultation by an experienced practitioner is in order.
Nasal surgery to correct breathing problems
Just because the x-ray did not show signs of fracture, that does not mean the nose was not broken. Very commonly what occurs is the upper lateral cartilages fracture off the nasal bones, dislocate, and push down inward into the airway creating valve collapse and vestibular stenosis. It is worsened on inspiration. In addition, the septum can be knocked out of place becoming deviated and crooked.
Septoplasty surgery is typically performed to improve the deviated or fractured septum. A rhinoplasty is not necessarily going to fix any deviation of the upper lateral cartilages. If the upper lateral cartilages are fractured off the nasal bones, a harvesting of septal cartilage can be performed with placement of spreader grafts to open up the nasal valve and reduce the vestibular stenosis. This is usually done out of medical necessity for a breathing problem. If there is not a breathing problem, then this is a component of the rhinoplasty procedure that can be done.
Have a thorough nasal exam for breathing problems post Rhinoplasty
If there is no visual nasal deformity, a rhinoplasty is probably not necessary. A thorough nasal exam should be done to accurately determine the cause of your obstruction. Another surgery may not sound appealing, but may be your best option. I suggest getting more than one opinion.
Functional Rhinoplasty for Complex Nasal Obstruction
Individuals who suffer from persistant nasal obstruction after septoplasty, nasal fracture, or cosmetic rhinoplasty may benefit from a Functional Rhinoplasty, the nasal operation that treats complex nasal obstruction.
There are several anatomic reasons for nasal obstruction, and certainly a deviated septum is one of them. Fixing it, however, doesn't always guarantee improved breathing, especially if you have narrow nasal valves that may have been aggravated by the trauma. It is quite possible that you did not benefit much from the septoplasty because a nasal valve problem was not addressed. (Ideally, nasal valve problems are diagnosed before surgery, so that the septoplasty and functional rhinoplasty can be performed together).
The Nasal Valve is the choke point of the nasal airway, and it tends to trump all others if it is narrowed because it is VERY sensitive to very small changes in size. During the procedure (also called a Nasal Valve Reconstruction), cartilage grafts are fashioned and placed in very specific areas to increase the size of the nasal valve cross-sectional area, and stabilize the valve so it is less likely to collapse with inspiration. Other manuevers, including suture methods to improve the valve area and tip-lifting methods have also been described to improve nasal valve narrowing, but the mainstay of therapy are spreader grafts and batten grafts.
A good thing about functional rhinoplasty is that it doesn't really affect the appearance of your nose and has no cosmetic benefit. It is purely a procedure to improve your breathing, and therefore is often covered by insurance. If there are cosmetic concerns, however, your rhinoplasty surgeon can easily piggyback the cosmetic changes in conjunction with the breathing portion (the cosmetic portion is self-pay since it is not a covered service). Therefore, you can look better and breathe better!
Sorry for the long answer, but my advice is to see an experienced rhinoplasty surgeon and have him/her examine your nose and nasal valves. You may be a candidate for correction of your complex nasal obstruction with a functional rhinoplasty!
Rhinoplasty to correct breathing problems after 2 Septal operations
"It feels like my right nostril is always more open than the left." Has it been this way after the first septum operation/ Did the second septal operation make it better? If so - when did things get worse again?
Your left nostril block may be real or it may feel like an obstruction. Several factors could contribute to the feeling of a block; Septal collapse / re curvature, enlarged turbinates (which may not have been addressed the first two times), OVER resection of the turbinate (which when gone feels the feel of a blocked airway).
Short advice - gather you medical records, especially your operative notes and see an experienced nose surgeon. To help you, you need to be examined by someone who can follow your history and correctly diagnose what is currently wrong.
Nasal Obstruction, septoplasty, rhinoplasty and breathing
There are a variety of reasons why you may have an obstruction. This may be mechanical and due to physical obstruction or due to physiologic reasons such as allergies. What complicates the matter is that actual measurements of air flow (called rhinometry) do not always correlate with subjective symptoms of obstruction.
Rhinoplasty does not generally improve breathing it and of itself and can in some instances aggravate nasal obstruction. Specific maneuvers to "open the airway" are indicated based on the physical exam. These can include medical and surgical treatments.
See a revision rhinoplasty specialist
The most important issue is the diagnosis of what the problem is after having 2 prior operations. If the external nose is not deviated a rhinoplasty is not usually needed. See an experienced rhinoplasty surgeon and let him guide you as to your next procedure.
Rhinoplasty is not indicated to fix internal breathing problems, although sometimes the placement of a "spreader" graft in the internal valve area of the nose improves breathing.
To improve your breathing, first you must be examined to get a diagnosis of what's the cause of your obstructive breathing. Consider your inferior nasal turbinates which can be treated with a simple office procedure called Somnoplasty which uses radiofrequency energy to heat and shrink excessive turbinate tissue.
If the external appearance of your nose bothers you, then you should consider rhinoplasty.
Choose your nasal surgeon most carefully.
Good luck and be well.
Diagnosis: Most Important Part of Nasal Issues
The most important step in treating nasal obstruction is diagnosis. Once you know what is the cause of the obstruction, treatment is a lot easier. In your care here are the possibilities.
1. Septum has become crooked again.
2. Its not the septum but turbinate glands are swollen. These can respond well to nasal steroid sprays and shrink and let you breathe again. If that does not work then turbinate surgery will help.
3. Nasal valve issues: The area between the side walls on the nose where it meets the nasal septum can be narrow. That can be improved only by surgery. The surgery for that can sometimes be septoplasty or can be called Functional Rhinoplasty.
4. Scar tissue build up between turbinate glands and nasal septum. That can be removed by surgery.
Nasal breathing can be improved for most patients without rhinoplasty
As I tell most of my patients who have breathing difficulties from a deviated septum, breathing can be improved without any external changes to the nose. That is if the problem is only from a deviated septum. Sometimes, which may be your case, the nasal valve can be affected. This is when the nose is traumatized, not only is the septum inside knocked off center but the support of the mid portion of the external nose is also changed. This area is supported by the upper lateral cartilages that attache to the nasal bones.
So, if you still can't breathe after two septoplaties, maybe the upper lateral cartilage on one side is pushed inward. There are a number of procedures that can fix this situation. They involve more than a Septoplasty. There is some external surgery but little change to the appearance of the nose. I suggest you seek out a specialist in both ENT and revision rhinoplasty for an opinion.