Often in my San Francisco plastic surgery practice, patients are referred to me for septoplasty. As a triple board-certified plastic surgeon with special training in otolaryngology (head and neck surgery), I am specifically qualified to help patients with septum-related issues, such as a deviated septum and turbinate reduction nose surgery here in San Francisco.
What is Septoplasty?
Septoplasty is traditionally taught in otolaryngology training programs as access and removal of blockages through incisions in the septal membrane in the front of the nose. The area is then removed by cutting out the cartilage, chiseling the bone and/or removing bone with a biting or cutting instrument. Packing is then placed in the space to reduce the chance for hematoma formation.
The problem of this approach is it is usually more surgery than is needed. It doesn’t always solve the problem and can lead to instability, perforation, recurring obstruction due to cartilage memory, and recurring bending of the internal septum leading to persistent breathing difficulty, and lastly a persistent curvature in the appearance of the nose.
No, septoplasty is not a cosmetic procedure and yes, it is a functional procedure that may be covered by insurance. However, I do not accept insurance at my San Francisco plastic surgery practice. Often, insurance carriers will not authorize treatment of a crooked nose since the nasal obstruction associated with it can be fixed with traditional septoplasty techniques. This sometimes results in suboptimal correction.
In order to achieve an optimal correction, a more technically-difficult procedure is required. At my San Francisco plastic surgery practice, I perform septoplasty surgery by repositioning the prominent portion of the curved septum. This technique is more effective in reducing breathing obstructions and maintaining the structural stability of the nose since it can often be done without sacrifice of cartilage and bone, which are vital to the support of the nose. The side benefit of this septoplasty technique is a straighter-appearing nose. This takes more time and effort and of course more skill to execute the required techniques.
How is the nose less stable with traditional septoplasty?
When a rectangular piece of cartilage is removed from the nose during a traditional septoplasty, there is less stiffness in the nasal wall. This reduces torsional resistance between the tip and mid-nose, making the nose easier to move side to side and, more importantly, the tip has less support, making it more likely to be compressible.
Conservation septoplasty, which I perform at my San Francisco plastic surgery practice, preserves the cartilage and bone as much as possible. This allows preservation of the support of the nose while improving the nasal obstruction as much as possible with the side benefit of a straighter nose for patients seeking to correct a crooked septum. This approach moves the cartilage and bone without removal and fixation of the structures with suture and cartilage-shaping techniques that are utilized in traditional septoplasty. By realigning the septal cartilage, the nose curvature and sometimes nostril asymmetry can be improved.
Can Septoplasty Be Combined with Rhinoplasty?
Septoplasty to improve nose functionality is often combined with aesthetic rhinoplasty to improve the appearance of the nose as well.
Some rhinoplasty techniques that are still used today to alter the shape of the nose have had detrimental effects on the function of the nose, such as reducing air flow, moisturization filtering and warming. These can result in obstruction, drying, crusting, and increased irritation, sometimes resulting in excessive mucus and a runny nose.
These techniques can affect the aesthetic appearance of the nose in the long term, resulting in the opposite of what was intended, such as a pinched tip, mid-nose collapse (inverted “V” deformity), asymmetry (twisting, leaning, up-turning tip) and skin surface deformities, to mention a few common deformities that I see and treat.
The best treatment is prevention by choosing a board-certified plastic surgeon to perform your rhinoplasty surgery. Of course, if you suffer from one or more of these nose deformities due to surgery or natural causes, then a structural restoration with septoplasty and/or rhinoplasty is a long-term fix to improve both the aesthetic appearance and functionality of your nose.