Should I see an ENT or plastic surgeon?

There are both plastic surgeons and ENTs who can take care of both issues at the same time.  Choose your surgeon in either specialty based on experience and results and go on a few consults.  Anybody who can take care if the aesthetics will likely be able to deal with the breathing regardless of whether it's a plastic surgeon or ENT.

Dear FacesbyPriya,A facial plastic surgeon would be your best bet as they are trained in both cosmetic and functional medicine. I would recommend finding a surgeon with a lot of septorhinoplasty experience. It is important to look at before and after photos and find a surgeon that you feel comfortable with. Best regards,Nima Shemirani

Commonly ENT surgeons can address your breathing concerns, but may refer you to a plastic surgeon to discuss cosmetic goals.  You may benefit from finding a plastic surgeon who also specializes in septoplasty surgery for breathing concerns so one surgeon can address both components.  

I think you are fine seeing either one - as long as they have dedicated experience in performing septorhinoplasty. Someone who is an expert in rhinoplasty should have sufficient skills in helping to improve your nasal function while also improving the appearance. Make sure you see plenty of patient examples that show the aesthetic of the surgeon. I have provided a link below that helps you understand many of the common rhinoplasty issues patients like you may face. 

When it comes to cosmetics both Facial Plastic surgeons and General Plastic Surgeons do good work. When it comes to breathing improvement and internal nasal surgery, Facial Plastic Surgeons have the advantage of having Ear-Nose-Throat training. I would not recommend an ENT doctor do the cosmetic aspect of your nose. Ideally a Facial Plastic surgeon who performs only scarless rhinoplasty as 100% of his surgical practice (aka doesn't do facelifts and eyelid and breast and body surgery). All the best 

You can (and perhaps should) see both ENT and plastic surgeon(s) to decide upon the physician you believe with greatest confidence can provide for you the rhinoplasty result which, both functionally and aesthetically, will most approximate or surpass your desired outcome.

Dear FacesbyPriya in San Diego, CA: 
There are surgeons whose practices are nearly all nose work.  Typically those surgeons will focus on nose work to the exclusion of the other.  So, more important than the specialty is the degree of superspecialization with respect to procedures performed.  I am aware of many surgeons in your area, as well as other parts of the county who have the credentials, experience, and talent to satisfy you.  Ideally, the breathing problem and the cosmetic changes should be made at the same time.  No reason to have two separate operations.  Often the functional issues, perhaps a crooked septum, impact on the appearance.

Be sure to do your homework to determine which surgeon would best serve you.  Read books and visit websites.  Read reviews.  On the doctors’ websites look for the before and after galleries.  See if the noses look natural.  What you want to find, ideally, is someone who is superspecialized, has a long train of experience, and whose work you can easily evaluate.  Computer imaging at consultation is very important and I would recommend bringing a friend or family member with you.  Takes notes at the consultation but, of equally importance, bring a list of questions.  All of the homework you do up front will help lead you to the best surgeon for your particular need.

Best wishes,

Robert Kotler, MD, FACS 

I would recommend a physician that specializes in both functional and cosmetic surgeries. Facial Plastic Surgeons are plastic surgeons with an ENT background and are very knowledgeable with these specific concerns. It is possible to achieve functional as well as cosmetic improvement with a physician that can address all concerns.

The key would be to find an experienced surgeon who does a reasonable number of rhinoplasties with septoplasty, so you can evaluate the cosmetic appearance and also ascertain what options the surgeon can comfortably offer you for improvement in nasal breathing. Most of us board certified plastic surgeons have good experience in septoplasty as well as repair of injuries to the septum, and we are trained in performing septoplasty with turbinate surgery as well as cosmetic rhinoplasty. For example, I wrote a research paper in residency on the effects of certain maneuvers in septorhinoplasty on the diameter of the nasal passages and the potential impact on breathing. However, ENT surgeons, especially those who have done an additional fellowship in what is commonly referred to as "facial plastic surgery" (a source of some frustration for board-certified plastic surgeons and the cause of the occasional turf war over patients), are also highly qualified to address both breathing and cosmetic concerns in the nose. It is really about your level of comfort with the surgeon's consultation information, before and after photos, and ability to explain the surgery clearly to you that would make the difference. Having said that, going to a plastic surgeon who primarily does hand surgery or an ENT who mainly does ear tubes and tonsils is not the best strategy but that's pretty self-explanatory.

A facial plastic surgeon has additional qualifications/ training/ experience and being board-certified in facial plastic surgery in addition to ear nose and throat surgery. A facial plastic surgeon should be able to handle both functional and cosmetic aspects to the nose. Rhinoplasty is much more difficult than a septoplasty, so choose your rhinoplasty specialist based on extensive experience.