Very commonly patients will come to my practice and ask “Can you fix my deviated septum during the rhinoplasty?” The answer is, of course, but there is always some confusion regarding the relationship between the internal structure of the nose, and the external structure. Particularly, how breathing relates to the nose and how structures that obstruct the nose can affect the appearance of the nose. Let me explain, as I address some of the most common questions asked by patients during consultation. As a surgeon certified by both the American Board of Otolaryngology (ENT), and the American Board of Plastic Surgery, our practice has unique expertise in this particular topic.
Is deviated septum related to breathing issues?
Commonly, the answer is yes. However, there are other factors to consider in patients who have difficulty breathing. There are structures call turbinates inside the nose which can become inflamed and cause blockage. But when patients do have severe deviations of the nose it is very clear that this is causing major obstruction. We perform specific examinations in the office to verify this including blocking one side of the nose and having patients breathe in and out slowly.
In addition, though, other anatomic issues such as collapse of the nasal bones and collapse of the nostril ( external nasal valve), will also cause nasal obstruction. For many patients, when breathing through the nose you can see the sides of the nasal tip collapse very easily. These patients will also have breathing issues.
During your consultation, Dr. Narasimhan will examine the internal as well as the external nasal valve of the nose to see which anatomic issue is related to your breathing. This is one of the most important aspects of surgical planning.
Does Deviated Septum affect my appearance?
Yes, a very deviated septum can affect the external appearance of the nose. If you look at yourself from the frontal view, you may be able to see a C-shaped deformity of the septum. This is related to the bowing of the cartilage that occurs in deviations. This is corrected with structural grafts from the nasal septum which can buttress or strengthen the integrity of the septum.
The patient above had a C-shaped septum from on the left (before). We placed a spreader structural graft to straighten the nose. In the after photo (right), the nose looks straighter when the light hits the nose.
Do you fix the septum when you do my rhinoplasty?
The answer is, always. Even if the patient does not complain of nasal obstruction or deviated septum, we do perform a septal cartilage restructuring to straighten the nose. As I always tell patients, a nose that breathes better, looks better. We address form and function in every single rhinoplasty. As a trained ENT and plastic surgeon, I need to ensure that the nose functions optimally.