About a year ago I underwent a septoplasty to correct a severely deviated septum that resulted from a broken nose when I was younger. My surgeon removed what must of been sizeable bone spur that was obstructing the nasal passage which definitely helped with my breathing. Unfortunately, it did little to correct the aesthetic appearance of my nose. The septum is still very deviated midway up the nose so it has maintained its crooked appearance. This is due to the septum pushing out against the nostril while the other "droops". Furthermore, my right nasal bone is caved in slightly due to the break adding to the appearance of crookedness/curve. When I consulted a plastic surgeon a bit later about the possibility of a septoplasty revision he said it would not be worth it considering a lot of cartilage was removed. This would make it hard to re-anchor/attach the septum and would also increase the risk of perforation. What can i do to fix this asymmetry? Is a rhinoplasty still possible? And what can be done about the crushed right nasal bone? I have considered fillers to even out the appearance of the curve and create symmetry. Though i'd want permanent results, Is this a better option? Thanks in advance!
Answer: Rhinoplasty after septoplasty
The septoplasty operation is specifically designed to improve airflow dynamics through the nose, not to correct a crooked nose. The concaved appearance of the upper lateral cartilages on one side or the other is best addressed by harvesting residual septal cartilage and placement of a spreader graft on the concave and flail side that has herniated into the airway. If the nose is cartilage depleted, then a small ear cartilage graft can be employed. Any irregularities in the bone will be addressed through osteotomies to make the nose more symmetrical.
Helpful
Book a virtual consultation
CONTACT NOW Answer: Rhinoplasty after septoplasty
The septoplasty operation is specifically designed to improve airflow dynamics through the nose, not to correct a crooked nose. The concaved appearance of the upper lateral cartilages on one side or the other is best addressed by harvesting residual septal cartilage and placement of a spreader graft on the concave and flail side that has herniated into the airway. If the nose is cartilage depleted, then a small ear cartilage graft can be employed. Any irregularities in the bone will be addressed through osteotomies to make the nose more symmetrical.
Helpful
Book a virtual consultation
CONTACT NOW November 2, 2011
Answer: Septoplasty: probably necessary. Rhinoplasty perhaps not.
Hello;
If the septum is still deviated, particularly if it's causing a nasal blockage, then the septum must be re-operated on.
It sounds like it's needed because if it is distorting the lower portion or tip portion of the nose, then it does need to be corrected. The revision rhinoplasty surgery will reveal that.
With respect to the outside of your nose: if straightening the septum straightens the outside, bravo!
If it does not, however, another option may be, not necessarily a revision rhinoplasty, but rather fillers instead to correct the depression, particularly on the right side.
Only when the septum is straightened will the surgeon know exactly what it has, or has not, done.
My advice: have a very detailed re-consultation with the original surgeon. Also, a second opinion is always worthwhile.
Each surgeon must do a very thorough examination of the nose, particularly by anesthetizing and shrinking the inside so the existing architecture can be seen, as well as whatever tissues may have been removed in the original surgery.
The more information a surgeon has, the better the choices that will be available to him and to you.
Do not dismiss the filler option because it is very difficult often to get an ideally straight nose that is a bit crooked, and particularly if there is some depression of the bony or cartilaginous elements.
Good luck!
Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION
Helpful
Book a virtual consultation
CONTACT NOW November 2, 2011
Answer: Septoplasty: probably necessary. Rhinoplasty perhaps not.
Hello;
If the septum is still deviated, particularly if it's causing a nasal blockage, then the septum must be re-operated on.
It sounds like it's needed because if it is distorting the lower portion or tip portion of the nose, then it does need to be corrected. The revision rhinoplasty surgery will reveal that.
With respect to the outside of your nose: if straightening the septum straightens the outside, bravo!
If it does not, however, another option may be, not necessarily a revision rhinoplasty, but rather fillers instead to correct the depression, particularly on the right side.
Only when the septum is straightened will the surgeon know exactly what it has, or has not, done.
My advice: have a very detailed re-consultation with the original surgeon. Also, a second opinion is always worthwhile.
Each surgeon must do a very thorough examination of the nose, particularly by anesthetizing and shrinking the inside so the existing architecture can be seen, as well as whatever tissues may have been removed in the original surgery.
The more information a surgeon has, the better the choices that will be available to him and to you.
Do not dismiss the filler option because it is very difficult often to get an ideally straight nose that is a bit crooked, and particularly if there is some depression of the bony or cartilaginous elements.
Good luck!
Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION
Helpful
Book a virtual consultation
CONTACT NOW
November 1, 2013
Answer: Rhinoplasty can be safely performed after septoplasty but seek an experienced surgeon Rhinoplasty can be safely performed after septoplasty but seek an experienced surgeon. An experienced Facial Plastic or Plastic Surgeon will be able to deal with the increased risks of revision septal surgery. The main limitation in performing rhinoplasty after prior septoplasty if finding adequate cartilage to rebuild the structural support of the nose. If this cannot be obtained from the nasal septum it can be readily obtained from the ear, cartilage portion of a rib or cadaveric donor tissue (my last choice due to some issues with warping and resorption). Fillers are a temporary solution and not without risk such as skin necrosis when used after prior nasal surgery. Further, fillers are camouflage. They are not a structural or permanent solution to your concerns. Thank you for your question.Stephen Weber MD, FACS
Helpful
Book a consultation
CONTACT NOW November 1, 2013
Answer: Rhinoplasty can be safely performed after septoplasty but seek an experienced surgeon Rhinoplasty can be safely performed after septoplasty but seek an experienced surgeon. An experienced Facial Plastic or Plastic Surgeon will be able to deal with the increased risks of revision septal surgery. The main limitation in performing rhinoplasty after prior septoplasty if finding adequate cartilage to rebuild the structural support of the nose. If this cannot be obtained from the nasal septum it can be readily obtained from the ear, cartilage portion of a rib or cadaveric donor tissue (my last choice due to some issues with warping and resorption). Fillers are a temporary solution and not without risk such as skin necrosis when used after prior nasal surgery. Further, fillers are camouflage. They are not a structural or permanent solution to your concerns. Thank you for your question.Stephen Weber MD, FACS
Helpful
Book a consultation
CONTACT NOW
FIND THE RIGHT
TREATMENT FOR YOU
October 24, 2011
Answer: Rhinoplasty revision or fillers? Fillers are easy to balance a crooked well functioning nose. A revision surgery will do this permanently IF you choose an experienced revision rhinoplasty surgeon.
Helpful
Book a virtual consultation
CONTACT NOW October 24, 2011
Answer: Rhinoplasty revision or fillers? Fillers are easy to balance a crooked well functioning nose. A revision surgery will do this permanently IF you choose an experienced revision rhinoplasty surgeon.
Helpful
Book a virtual consultation
CONTACT NOW
October 24, 2011
Answer: Rhinoplasty after Septoplasty
Rhinoplasty after septoplasty can be tricky. It has to be handled the right way by someone with experience in cosmetic and functional surgery in order to avoid the issues you describe. It sounds like you had a submucus resection type septoplasty where the non-structural cartilage is removed. That is unfortunate but no uncommon either. What is left is the structural parts of the septum, also referred to as the L-strut.
That L strut can be manipulated, provided the surgeon appreciates what your margin of safety is. The deviation can still be addressed and further straightening of your airway should be possible. If cartilage grafts are required, then ear cartilage is likely required, since your septum can no longer be used for that purpose. There can be limitations on profile reduction, depending on how much cartilage is left on the top of the nose.
If the majority of the septum is not instrumented again, then your risk of perforation should be very low. There is no real reason to re-do the septoplasty, unless crooked cartilage is still present. If that is the case, then the perforation risk is not particularly high.
Found the right surgeon and your goals should be achieved.
Best of luck
Helpful
Book a virtual consultation
CONTACT NOW October 24, 2011
Answer: Rhinoplasty after Septoplasty
Rhinoplasty after septoplasty can be tricky. It has to be handled the right way by someone with experience in cosmetic and functional surgery in order to avoid the issues you describe. It sounds like you had a submucus resection type septoplasty where the non-structural cartilage is removed. That is unfortunate but no uncommon either. What is left is the structural parts of the septum, also referred to as the L-strut.
That L strut can be manipulated, provided the surgeon appreciates what your margin of safety is. The deviation can still be addressed and further straightening of your airway should be possible. If cartilage grafts are required, then ear cartilage is likely required, since your septum can no longer be used for that purpose. There can be limitations on profile reduction, depending on how much cartilage is left on the top of the nose.
If the majority of the septum is not instrumented again, then your risk of perforation should be very low. There is no real reason to re-do the septoplasty, unless crooked cartilage is still present. If that is the case, then the perforation risk is not particularly high.
Found the right surgeon and your goals should be achieved.
Best of luck
Helpful
Book a virtual consultation
CONTACT NOW