Can a rhinoplasty cause a deviated septum?

Question

I had a closed rhinoplasty to remove a dorsal hump 4 months ago. Now I am able to feel a high deviation in my nose. The septum veers to the right side. If I apply pressure to the septum it straightens out but only to move back shortly after. Half of an inverted V is also revealing itself on the outside of the nose on the right side around the same area. Can a rhinoplasty cause a deviated septum? And is it related to the inverted V? Can these be solved simultaneously?

Sam Naficy, MD, FACS · Answer

There are a few possibilities:1. There was an existing septal deviation that is now revealed2. The septum was weak and floppy and after rhinoplasty the structure of the nose was destabilized and the septum became deviated3. Your nose moved to one side (to make it more symmetric) , thus making a previously straight septum now appear deviated

Thomas A. Lamperti, MD · Answer

It isn't common for a rhinoplasty to cause a deviated septum, though it could be scar tissue or a pre-existing deviation that is more noticeable now. This is likely unrelated to the inverted-V but it should be possible to treat both issues at the same time.

Evan Ransom, MD, FACS · Answer

Thank you for the question. While it is unlikely that a deviated septum was caused by the rhinoplasty surgery, it could have been revealed by this. What I mean is that, in the process of lowering the height of your bridge (hump removal), the upper part of the internal airway is changed. If there was an area of deviation of the septum high up, then the lower bridge height could now be at the level of this deviation. Furthermore, since you mentioned an inverted-V, it is possible that the nasal bones and sidewall were destabilized during your surgery. A little collapse of this area could result in additional compromise of the nasal airway on one side. It would be best to see your surgeon and/or get a second opinion at this point. Take care and best of luck!

Chen Lee, MD · Answer

Thank you for your question. It is improbable that your high septal deviation was caused by the surgery. However, a preexisting high septal deviation may become unmasked  following the hump removal in rhinoplasty surgery. The post operative course usually shows the deviation progressively over several months as the swelling resolves to fully display the underlying septal distortion. 
The inverted V deformity you describe is from collapse of the internal valve resulting from hump reduction without restoring the normal relationship of the upper lateral cartilage to the septum. 
In my practice, I typically will use spreader grafts to address both problems in one technical maneuver. The spreader grafts will restore and correct the inverted V. The grafts also perform a second function. They will also internally splint the high septal deviation into a straighter position.

Can a rhinoplasty cause a deviated septum?

Answers (4)

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