Is getting an X-ray the only way to tell a deviated septum? Want to get breathing fixed and fix large nose at same time.(photos)

It is possible to have both of these areas addressed during the same surgery. Turbinate hypertrophy and septal deviation can both be addressed during an open rhinoplasty as can aesthetic concerns. Anterior rhinoscopy (looking inside the nostrils with a speculum) can diagnose most cases of septal deviation; however, sometimes imaging can help view the entire nasal passageway. Insurance companies usually cover septoplasty and turbinate reduction. Sometimes they will cover surgery for external valve collapse (can be done with a rhinoplasty). Insurance companies will not cover the part of the surgery dealing with aesthetic alone (tip definition, tip rotation, dorsal hump reduction, et cetera).Best of luck.Dr. Ashley RobeyBoard Certified Plastic & Reconstructive SurgeonBoard Certified Facial Plastic & Reconstructive SurgeonBoard Certified Otolaryngologist - Head & Neck Surgeon

Scanning techniques or a physical examination can help the surgeon make an assessment about the state of your septum. If your breathing and snoring issues are your main concern right now, you might consider having them fixed without any cosmetic intervention first. Especially if you do not want to pay any additional costs. As insurances will not cover cosmetic procedures.
If changing the look for your nose is also a priority for you and if you have the budget for it, I recommend seeing a rhinoplasty specialist and continuing with them. They will also address the health issues and fix your breathing problems.Hope this helps,Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

hello thank you for your question and provided information as well.. based in your question and the picture you showed i can fix it with a rhinoplasty with technique open to correct de desviated and elevate the tip and refined.

You need to see a rhinoplasty specialist.  If you want changes to the outside of your nose, especially profile changes, it is usually considered cosmetic.  In rare cases, some external changes would be necessary to improve breathing. Your nose does not appear to be grossly deviated from the photos you showed, but you might have some narrowing of the nasal valves.  Bottom line is - don't make it too complicated.  Go see a rhinoplasty specialist and talk about what you want to accomplish, functionally and cosmetically.  Let the surgeon then work out what has to be done and what it will cost you.  Computer morphing is helpful in my opinion.  Also, with great bias, I suggest you see a facial plastic surgeon who specializes in rhinoplasty, especially because you have functional issues. There is no indication for x-rays or CTs by the way.  

A speculum exam or naso endoscopy can easily diagnose a deviated septum. It is important to realize that removing the deviated portions of the septum can improve breathing. However it may have no effect on snoring and does not change the external nasal appearance.  A cosmetic rhinoplasty can improve the appearance . I recommend that you do a rhinoplasty at the time of a septoplasty, so that the removed cartilage could be used as grafts to improve the rhinoplasty results.
Best Regards, Prashant Soni M,D.

If your external nose is crooked, then it is extremely likely that you have a deviated septum. A CT scan or Xray are not required to determine this, although they are often able to do so. A physical examination with endoscopy photos is the most direct way to document your deviated septum, avoiding any radiation exposure associated with imaging studies.

Hello and thank you for your question. Based on your
photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose. You may also benefit from a cephalic rotation of your tip to turn
up your tip slightly and a dorsal hump reduction.  A septoplasty can be performed at the same time.  The best way to evaluate for a deviated septum is with an intranasal speculum examination.  Most insurance providers will cover the septoplasty portion of surgery.  Make
sure you specifically look at before and after pictures of real patients
who have had this surgery performed by your surgeon and not just a computer
animation system.  You should be able to
view numerous pictures of actual patients with noses similar to yours performed
by your surgeon.  If you cannot find
enough real before and after pictures, then consider continuing your search for
a surgeon. The most important aspect is to find a surgeon you
are comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

The diagnosis of a deviated septum is can be made with a CAT scan of the sinuses or just a physical examination.  A septoplasty is only performed for medical necessity if you are having airflow obstruction from the deviation of the septum.  A septoplasty is billed to the patient's medical insurance once preauthorization and medical necessity has been documented.  Co-pays and  Deductibles will also apply.  A  rhinoplasty is considered cosmetic, and must be paid for by the patient.  Both cosmetic and functional nasal surgery can be performed simultaneously under one anesthesia with one recovery period.  Rhinoplasty is much more difficult than a septoplasty procedure,  so choose your Surgeon very wisely based on extensive experience.  Study your  prospective surgeon's before and after photos make sure that it is extensive.

Septoplasty, turbinate reductions and external nose reshaping can all be done at the same time. Computer imaging should be done to determine what nasal shape changes you seek as well as what is a realistic outcome from the surgery.

Hi there and thence you for your question.
Usually, a meticulous clinical examination, which includes an endoscopic exam of your nose and clinical evaluation of your nasal breathing should be sufficient to identify the reasons for any airway blockage. If you have any problems with your Sinuses, a CT-scan should be performed. Nowadays, X-rays are not the first-choice method for endonasal diagnosis.
Best, 
Greg Bran MD PhD
Double board-certified Facial Plastic Surgeon