Should a Rhinoplasty or Septoplasty Surgeon Also Be an ENT Doctor?

The topic and operation "rhinoplasty" (nose job) is quite complex. There are different schools of thought. A lot of rhinoplasty techniques weaken the structural framework of the nose, possibly leading to cosmetic and functional problems of the nose in the long-run. It is therefore essential that the nose is being supported structurally with cartilage grafts (septum, ear, or rib), with the septum being by far the most favorable donor site. Ear or rib cartilage is typically only utilized if septal cartilage is insufficient or not present at all due to prior surgery, trauma, cocaine use, etc. It is therefore commonly recommended that a septoplasty is performed in conjunction with a rhinoplasty, not only to straighten the septum and thereby improve nasal breathing, but also to utilize the harvested septal cartilage to stabilize the nose to prevent pinching and collapsing from occurring in the long-term. While all Facial Plastic Surgeons have a background in ENT and hence are trained and equipped to perform septoplasties, not all Plastic Surgeons perform septoplasties, although many do. Therefore, instead of focusing on the specialty (Plastic Surgery vs. Facial Plastic Surgery), I would have a frank conversation with the surgeon(s) you consider whether or not he or she performs septoplasties. Also, you should look at pre-OP and post-OP photos of actual patients and decide if you like the surgeon's aesthetic preferences. And furthermore, you need to be comfortable with and confident in your surgeon! Whichever surgeon you choose, if no nasal endoscopy is performed during your consultation, chances are that this surgeon does not perform many (if any) septoplasties, as the entire septum cannot be evaluated unless a nasal endoscopy is performed in the office. At the end of the day, there are many opinions and preferences among rhinoplasty surgeons, and there is no right or wrong way. The consensus among the surgeons seems to be, though, that some sort of structural grafting is necessary for a successful rhinoplasty operation. Whether or not such is performed by a Plastic or Facial Plastic Surgeon is secondary. Best wishes!

Choosing a qualified surgeon is the most important decision you can make when deciding to under go nasal surgery because rhinoplasty is considered the most diffcult procedure in cosmetic surgery. Here are some tips for choosing a the right surgeon:

Choose a Rhinoplasty Specialist: First and foremost, choose an surgeon who specializes in nasal surgery. Your surgeon should be equally experienced at correcting both cosmetic problems and functional problems (such as a deviated septum).


Research Your Doctors Credentials: Your surgeon should be Board Certified in either Facial Plastics/Otolaryngology (ENT) or Plastic & Reconstructive Surgery. It is important, however, to know that not all ENTs or Plastic Surgeons routinely perform rhinoplasty. It is important to find one who does. Several resources that can help you find a surgeon include the AAFPRS (http://aafprs.org) and ASAPS (http://surgery.org).


View the Surgeon's Rhinoplasty Before & After Results. Most rhinoplasty surgeons maintain a portfolio of examples of their results that compare before and after photos, and many qualified rhinoplasty surgeons have a "Results Gallery" on their websites. You can tell a lot about your potential results by looking at their previous work.


Ask to See Simulated Results. Your rhinoplasty surgeon should analyze your pre-operative photographs with you and be able to show you graphically their intended results. Recently, new technology is allowing doctors and patients to view simulated results in 3D.

I think either type of surgeon can give you a nice result-- as long as the training and qualifications are there, I think you are at a good starting point. Ask lots of questions, see before and after photos and talk to some of their former patients-- this will give you the best chance at a positive result.

Hi Melashel,
Way to stir up the old specialty "wars".
ENT, Facial Plastic, and General Plastic Surgeons all perform septorhinoplasty. The surgical procedure is not a commodity, but an operation that combines the skill, experience, training, creativity, and aesthetic sense of beauty of the surgeon to achieve an attractive (cosmetic) as well as an excellent breathing (functional) result.
There are surgeons of all of the above cited specialities that perform the operation very well, and there are surgeons who do not. It is important to choose your rhinoplasty surgeon carefully. Ask questions, speak to previous patients, take your time.
The surgeon is more important than the speciality.
Good luck and be well.
Dr. P

When considering Rhinoplasty and Septoplasty, your surgeon's credentials and personal experience is critical.
You should find a board certified surgeon well trained in the art of nasal surgery. You should see many favorable before and after photos before proceeding. A frank discussion with your surgeon about your daughter's nasal airway will alleviate any concerns. Experienced nasal surgeons routinely correct septal deviations during Rhinoplasty, and also routinely harvest cartilage grafts from the septal cartilage to support the tip. If you have any doubts or concerns, get a second opinion from another board certified rhinoplasty surgeon with the criteria I listed above.
Best of luck.

The ability to perform a quality septoplasty in addition to a rhinoplasty really depends on the individual's training and experience. In general Facial Plastic Surgeons have ENT training prior to facial plastic surgery and learn the nose and sinuses inside and out. However, many Plastic Surgeons are also qualified and experienced in septoplasty. What is important is how well trained and how often your proposed surgeon performs both septoplasty and rhinoplasty; both as combined and separate procedures. Did the proposed surgeon even look inside your nose? Did they use a special headlight and nasal instruments. Even the exam can be an indicator of how comprehensive the nasal surgeon is that you have found. I am amazed when seeing consults for revision surgery, patients often state that their original surgeon never even looked inside their nose.

Both ENT doctors and plastic surgeons are trained in nasal surgery, usually both functional and external nasal surgery. But the training programs and experiences of each doctor may vary greatly. In some communities it appears that the ENT doctors do most of the nasal surgery and in other places the opposite is true.
You can not make a blanket statement that one is better than the other. I would question each doctor about their experience and their recommendations and base your decision on who you feel most comfortable with. Also, any rhinoplasty surgeon with a lot of experience should be able to show you literally dozens of before and after pictures of their own work.

It will depend on how many septoplasties the surgeon has done and how good he is at doing noses! In general, your doctor is correct. Usually ENT training is more extensive in nasal surgery issues. Having said that, you can find good and bad of both types of surgeons. Ask how many of these operations your doctor has done and what is his training in them.

Rhinoplasty and septoplasty are delicate operations which require experience and an aesthetic eye. Both otolaryngologists (ENT doctors) and plastic surgeons receive some training in these operations during training. The experience of these doctors after they enter practice can be quite different, with some performing many rhinoplasty procedures, and others almost none.
Therefore it is essential to find out who in your community does these operations both frequently and well. If there are significant functional problems it would be wise to enlist a doctor with training in these areas, usually someone with an ENT background and facial plastic surgery training.

Thank you for the question.  Anyone that is well trained in rhinoplasty surgery, performs enough rhinoplasty procedures to get good at it, does a good job of listening to his patients, and has a balance eye of aesthetics will be able to perform a septoplasty and rhinoplasty successfully.  There are some ENT surgeons that do not do rhinoplasty surgery and there are some Plastic Surgeons that do not do septoplasty surgery but these are far and few between.  In general, if you can do one very well you will likely be passionate and capable at doing the other well if there has been sufficient training.  Last but not least, you could always ask the prospective plastic surgeon about his/her experience with septoplasty surgery.

All the best,

Dr. Remus Repta