I broke my nose 5 days ago from an accident at home. I went to see a plastic surgeon today in NYC, found an MD on the net. I was told that I have a broken nose, and it's fractured with slight deviated septum. My nose is crooked a bit, but I can breathe fine. I just leave my noise alone. I am over 45 years old. Would I need to have a closed Rhinoplasty or Septoplasty?
Surgery Needed for Broken Nose and Slight Deviated Septum?
Doctor Answers 14
An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and provide true medical advice.
Nasal fracture repair
An acute nasal fracture should be treated in the first 2 weeks.
Many times a broken nose can be moved back to its initial shape in the office under local anesthesia. The bones can be straightened and a further surgery prevented. If you can't tolerate this then you can have the repair with a higher level of anesthesia. Many emergency rooms and even some doctors will tell you to wait several weeks before getting an evaluation. This is wrong. If you wait then the bones will knit and you will need a formal rhinoplasty after 2 months. You will only need a septoplasty if the deviated nasal septum is causing difficulty with breathing. If you have trouble breathing you will want to see someone who is also trained in otolaryngology as a general plastic surgeon has limited training inside the nose. Again, don't wait more than 2 weeks to have an acute nasal fracture repaired.
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Broken nose and deviated septum
If your breathing is good and the deviation is not concerning to you, you don't need surgery. If your breathing is affected, a septoplasty may help you. If you are interested, a rhinoplasty can straighten your nose.
If you're breathing fine and your nose is straight on the outside, there is no need to have surgery.
It is a good idea that you have gone to see a plastic surgeon after you broke your nose. It is important to make sure you do not have a septal hematoma. If your nose is indeed broken, displaced and crooked, it will need to be reset. This is performed through osteotomies of both nasal bones. This is technically not a rhinoplasty but a re-breaking and resetting of the nasal bones themselves. Most of the time when the nose is fractured the septum will be broken, twisted and deviated and should be repaired at the same time. It all depends on how twisted the septum is on the inside of the nose as to whether or not it needs to be fixed. If you are breathing fine and your nose is straight on the outside, there is no need to have any surgery. For many examples of rhinoplasty, and broken nose repair, please see the link below
Have the procedure only if you don't like what you see
If you are breathing fine, then you shouldn't need a septoplasty. You can wait a few more days to let the swelling go down. If the nose is still crooked and this bothers you, then you can have the closed reduction to straighten the nose. If you don't mind how the nose looks and you are breathing well, then do nothing.
Your nose is broken...now what?
If you're nose is broken and you're breathing okay, you don't have to get surgery! However, if your nose is crooked and you want it straightened, your surgery may involve putting the bones back to where they were (relatively simple with no incisions needed sometimes.) If you nose is very crooked, then you may require bone or cartilage grafts to help make your nose have a straight look. This is more involved and is usually done with an open approach. Good luck!
How to fix a broken nose
Generally speaking, nasal fractures can be repaired at 2 time points.
The first is a procedure called a closed reduction, where no cuts are made and the bones are just pushed back into place. Generally, it is recommended to do this procedure within the first 7-10 days. I have done it as late as 3-4 weeks in severely deviated noses. This is often done with some light anesthesia to make it comfortable. Sometimes the septum will move over with the bones. Often it will not.
The second is a procedure more like a rhinoplasty, where the bones are rebroken and set in the middle. This is usually done after 3 months of healing has occurred. This definitely requires anesthesia.
Although some surgeons will try to do a septoplasty soon after an injury, I prefer to wait until the inflammation is gone. This allows more precise correction of the cartilage, in my opinion. Therefore, I tell patients they should wait 3 months to get their septum fixed.
For cases like yours, I generally recommend to have a closed reduction and then wait 3 months. If the breathing problems are still present, then a septoplasty can be done. Most patients feel better and don't need the second surgery for breathing.
It sounds like you need a closed reduction of your nose fracture.
If your nose looks crooked after the trauma, but you're breathing fine, you should have this repaired. In general, you can have your nasal bones repositioned without "re-breaking" them within 10 days of your injury.
You can have a "closed reduction" of your nasal fracture performed with local anesthetic in the office, with minimal discomfort, and no downtime. If you wait longer than 2 weeks, you'll need a more extensive surgery with general anesthetic.
Since you're breathing fine, I don't think you need a septoplasty.
I hope this helps, and best regards.
After an acute fracture, I usually discuss the options with patients. If the nose is significantly deviated, the goal of early reduction ( within the first week to 10 days) is to centralize the bony and septal complex as best as one can. Bumps on the nasal dorsum or revisions of slight deviations, will then have to be treated at about 6 months when the majority of swelling has subsided and the fractures are healed. If you go in acutely to do rasping of bumps, etc.. more damage than good can result. If the patient does not have significant deviation, then I would wait to treat the nose for at least 6 months. If the nose looks close to normal after the acute injury, then I would be inclined to leave it alone.