When are external incisions needed for a Septoplasty?

Question

As it's rare to need incisions on the outside of the nose during a Septoplasty, what conditions warrant them? In the case they are needed, is a scar revision surgery required later on?

Thomas A. Lamperti, MD · Answer

The vast majority of septoplasty surgeries utilize a hidden internal incision. More complex repairs may require an open approach using a columellar incision. This is especially the case when the portion of the septum closest to the nostrils (caudal septum) is deviated and requires reconstruction.

	The columellar incision heals very well in my experience and very rarely needs scar revision. You should be able to find out what type of septoplasty approach you would need after consulting with your nasal surgeon.

Houtan Chaboki, MD · Answer

Septoplasty is one of the most common operations worldwide, primarily to improve nasal breathing, congestion, or snoring. Typically, septoplasty does not involve external incisions. Incisions are normally placed inside the nostrils, and surgeons will use stitches that dissolve. Routine septoplasty does not alter the appearance of the nose, as the surgery is on the inside of the nose. Occasionally, plastic surgeons may use an external incision for septoplasty. External incisions may be used of revision or complicated septoplasty procedures. The external incision heals very well and generally unnoticeable. After a comprehensive evaluation can a surgeon help determine appropriate options for you. Best of luck.

	Dr. Chaboki

Ivan Wayne, MD · Answer

In 90% of the septoplasty surgeries we perform, the incisions are located internally, along the edge of the septum. It would be very rare to see this incision after it was healed unless the surgeon did a poor job suturing it closed. In the other 10% of cases we choose to perform a transcolumellar incision to improve exposure in cases where the caudal (very end) septum is broken, very crooked or there is need to reinforce the caudal septum with a graft. As in the internal approach-if the external incision is carefully closed by your surgeon it should heal well and be difficult to see.

	I hope this helps...

Steven L. Ringler, MD, FACS · Answer

A septoplasty, by definition, is surgery to correct a deviated septum, which is the vertical cartilage that divides the nose into two sides. For many patients a deviated septum will cause airway obstruction but does not necessarily affect the external appearance of the nose. In these cases, a septoplasty can typically be performed through an internal nasal incision. If the deviated septum causes an external nasal deformity, then most plastic surgeons would recommend a “septo-rhinoplasty” which refers to treatment of both the internal and external nasal deformity. Many surgeons use an open approach for septo-rhinoplasty, which requires a small external incision between the nostrils.

Douglas J. Kibblewhite, MD · Answer

The majority of septoplasties can be done with incisions hidden inside the nose. Certain types of crooked septums, particularly those where the deviation is close to the from at the nostrils, are sometimes done with a standard external rhinoplasty incision in order to maximize the chances of a successful outcome. An external rhinoplasty incision is very hard to see.

Peter A. Aldea, MD · Answer

To do work on the septum surgeons must first peel the skin (mucosal) lining and expose the septum. This is done with several vertical incision on one side of the septum. Occasionally, an opern (transcolumellar) approach is done in rhinoplasty where the skin is lifted off the nose and the septum is exposed from the top via an open sky approach. In the vast majority of cases, septoplasty incisions heal with great, hardly visible scars.

	Peter A. Aldea, MD

Francis R. Palmer, III, MD (retired) · Answer

None that I can think of after more than 20 years performing Septoplasty and Rhinoplasty. The incisions for a Septoplasty are inside the nose along the front portion of the nasal septum. Be certain that your Rhinoplasty Surgeon understands and follows the proper aesthetics of facial (and nasal) beauty for the creation of a naturally more attractive nose.

Daniel Greenwald, MD (in memoriam) · Answer

Septoplasty alone is easily performed without an external incision. If there are to be elements of cartilage scultping for the tip or tif there are to be other cosmetic alterations than an open incision may be frequently employed.

Richard P. Rand, MD, FACS (retired) · Answer

On some occasions your surgeon may feel that they will get better exposure to a complicated deviated septum by doing it "open." This scar will almost always be invisible and virtually not an issue if it means getting the best airway the first and only time you need surgery.

When are external incisions needed for a Septoplasty?

Answers (9)

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