Septoplasty in NYC

Yes, septoplasty can be performed alongside other procedures, such as rhinoplasty (cosmetic nose surgery) or sinus surgery, depending on your specific needs and goals.

When septoplasty is performed in conjunction with rhinoplasty, the surgeon can address both the functional issues associated with a deviated septum and enhance the overall appearance of the nose. This means that not only can airflow be improved, but you can also achieve a more balanced and harmonious nasal aesthetic. Many patients appreciate the opportunity to address these concerns simultaneously, as it often results in a more comprehensive solution with a single recovery period.

Similarly, if you are experiencing chronic sinus issues along with a deviated septum, combining septoplasty with sinus surgery can help alleviate both problems in one surgical session. This dual approach can enhance your quality of life by improving both your nasal function and overall sinus health.

Endoscopic sinus surgery uses tiny surgical telescopes called endoscopes to explore inside the sinus openings. They can then be surgically enlarged to enhance fluid drainage from the sinuses and prevent backup of mucus and bacteria.

Surgery of the sinuses may be a simple opening of the sinus outflow tracts called the middle meatus, or more aggressive cleaning out of the sinuses depending on the extent of sinus disease. CT scans and correlation with the response to medical treatment will help determine how extensive sinus surgery needs to be.

Endoscopic sinus surgery is frequently performed at the same time as septoplasty since a deviated septum is often a significant contributing factor. It can also be safely done in conjunction with cosmetic rhinoplasty.

On the day of your surgery, it’s important to adhere to fasting instructions. Typically, you will need to refrain from eating or drinking for a specified period of time before the procedure, especially if general anesthesia will be used. Make arrangements for transportation, as you will not be able to drive yourself home. It’s advisable to have someone accompany you to the surgical center or hospital. Our office operating room nurse will conduct a comprehensive meeting with you, in person or over the phone, to go over the entire process and all do’s and don’ts in advance of surgery.

Dress comfortably on the day of the surgery by wearing loose-fitting clothes that are easy to put on and take off, buttoning up the front. Avoid makeup, jewelry, and contact lenses, as these can interfere with the procedure.

At home, prepare a recovery space where you can rest after the surgery. Stock up on necessary supplies, such as ice packs, extra pillows, and any prescribed medications. Consider arranging for someone to assist you during the first few days of recovery, particularly if you have children or other responsibilities that require attention.

Every patient being considered for nasal surgery, even cosmetic rhinoplasty (commonly called a “nose job”) should have a thorough examination of the inside of the nose to check for a deviated septum. That’s because any nasal surgery could make a deviated septum more symptomatic and suddenly create nasal blockage.

Even a few millimeters of narrowing of the sidewalls of the nose that usually occurs with rhinoplasty could make this small deviation of the septum more important and now cause obstruction. This is based on the physics of Bernoulli’s Law pertaining to air flowing through a column.

So, if a deviated septum is present, it needs to be fixed, even if the patient came in for a cosmetic rhinoplasty. Otherwise there is the risk of creating a new problem. Some patients may not even realize that they have been breathing predominantly out of only one nostril until it’s pointed out at the time of examination. It is also astounding when patients come in for a revision rhinoplasty with breathing issues and report that their surgeon never even looked inside their nose because it was just a cosmetic rhinoplasty.

Other structures in the nose that also contribute to the nasal airway are called turbinates. There are three turbinates on each side of the nose: lower, middle and upper. They are curly bones that are also covered by mucosa.

The turbinates help channel the air we breathe along a direct path from the nostril to the back of the throat then down into our lungs; this is called laminar flow. The turbinates also swell to warm and humidify the air we breathe and as a reaction to colds and allergies.

You could be outside in cold, dry air, and by the time the air gets to your lungs it is 98% humidity and body temperature.

This is mostly a function of swelling of the turbinates. The turbinates also have a natural cycle where one side swells and 6 to 8 hours it alternates to the other side.

Sometimes you may cover one of your nostrils and the airflow is good, but when you switch, the other is less. This cycle will alternate sides. Rarely do people breathe fully through both nostrils at the same time.

The nasal cycle is also affected during sleep. The downhill nostril will swell by gravity and you breathe more through the uphill nostril. This is why when you turn over there is a brief wave of air you feel. It’s the uphill nostril opening up.

The nasal septum is the wall in the center of the nose that divides it into two sides. The front 2/3 is made of cartilage and the back portion is thin bone.

The septum, as well as the entire nasal cavity is lined by smooth shiny skin called mucosa that covers the cartilage and bone.

The septum sits on a small groove of bone called the maxillary crest that is the top of the bone that makes the palate (roof of the mouth). The septum extends from the floor of the nose to the bridge above and all the way down to the nasal tip below. If you put your finger in your nose and feel a wall in the middle, that’s your nasal septum.

Internal valve issues of excessive narrowing of the upper lateral cartilages after cosmetic rhinoplasty is one of the most common issues addressed in revision rhinoplasty. The treatment is the placement of grafts of your own cartilage to support that internal nasal valve, called spreader grafts.

These grafts are usually taken from nasal septal cartilage. Since we found that this issue was occurring so often, most rhinoplasty surgeons, including Dr. Pearlman, actually place spreader grafts in primary rhinoplasty to prevent internal valve issues in the first place in many patients.

The external nasal valve is lower down in the nose and comes from the strength and support of the nostrils by the tip cartilages called the lower lateral cartilages. The external nasal valve can be compromised or narrowed by a number of causes: too much cartilage is removed from the nasal tip during rhinoplasty, sutures used to narrow the nasal tip are too tight or the shape and position of the lower lateral cartilages are such that they don’t offer sufficient support for the nasal airway.

The treatment for a narrow nasal valve is common during revision rhinoplasty, or even preventing one in the first place during primary rhinoplasty is also by the use of cartilage grafts. These are called alar struts, spreader grafts or batten grafts.

The nasal valve is the narrowest part of the nose. It is actually divided into two parts: internal valve and external valve. When you have nasal obstruction, it is sometimes from nasal valve issues in addition to, or instead of, a deviated septum or enlarged nasal turbinates.

The internal nasal valve is in the middle third of the nose. The cartilages called the upper lateral cartilages insert into the nasal bones above and intersect with the top of the nasal septum in the midline.

If you run your finger down the side of your nose, you will likely feel a drop off below the top third of the nose. This is where the upper lateral cartilage is inserted under the nasal bone.

When a nasal hump is removed and the gap closed, the upper lateral cartilages may get even narrower.

Initial recovery typically takes about 1 to 2 weeks, during which you may experience swelling inside your nose, congestion, and mild discomfort. Externally, you should look exactly the same within days of surgery. Most patients can return to normal activities within 2 weeks, but complete healing of the nasal structures may take several months.

You will have some bruising and swelling around the eyes during the first week of recovery. Some patients need time to adjust to breathing through their mouth; it’s akin to having a mild cold. Fatigue from the anesthesia is common for the first day or two. Patients should rest the first few days in an upright position to minimize swelling for better healing.

Septoplasty primarily focuses on correcting a deviated septum to improve breathing and nasal function, rather than changing the external appearance of the nose. Performed from inside of the nose, this procedure causes no change to the outside of the nose in most cases. 

However, if your septum is significantly deviated, some patients may notice slight changes to the shape of their nose post-surgery. If cosmetic changes are a primary concern, discussing this with your surgeon is important. They may recommend combining procedures, such as with rhinoplasty, to achieve the desired aesthetic outcome.

Septoplasty alone has no effect on the appearance of your nose. There is no external splint or cast. Some patients choose to have cosmetic surgery at the same time. If you choose to, you may have a combination of a septoplasty and rhinoplasty (septorhinoplasty) to alter the way your nose looks along with breathing functionality.

Septoplasty will long lastingly straighten a deviated septum. However, nasal obstruction may also be due to other anatomic and functional issues. For most patients, they experience long lasting improvement in breathing.

Septoplasty can significantly improve breathing for many individuals by correcting a deviated septum, which can obstruct airflow. However, while many patients experience lasting relief, the results can vary based on individual circumstances. Factors such as the degree of deviation, overall nasal structure, and any underlying conditions (like allergies or chronic sinusitis) can influence long-term outcomes.

In some cases, if the nasal passages develop new issues over time or if other anatomical problems arise, additional treatments may be necessary. It’s important to have a thorough consultation with a septoplasty specialist, who can assess your specific situation and provide guidance on what to expect after your septoplasty in NYC.

If you have blockage of your breathing and documented treatment for nasal obstruction, insurance can often cover septoplasty surgery. This will be only for the functional procedure of septoplasty, not rhinoplasty.

Insurance coverage for septoplasty often depends on your specific policy and whether the procedure is deemed medically necessary. If a deviated septum is causing significant breathing problems, chronic sinus issues, or other health concerns, many insurance plans are more likely to cover the surgery.

It’s essential to check with your insurance provider to understand your coverage options, as well as to obtain any necessary pre-authorization. Additionally, Dr. Pearlman can help by documenting the medical necessity of the procedure, which may improve the chances of coverage. Always confirm the details with both your insurance and your healthcare provider to ensure you have the most accurate information.

No, there will not be visible scars after septoplasty. The procedure involves making incisions inside the nostrils, which means any scars are internal and not externally visible. This approach helps maintain the aesthetic appearance of the nose while effectively addressing the structural issues associated with a deviated septum. Rarely, for extremely deviated septums, we might need to use an open rhinoplasty approach, in which case Dr. Pearlman will help you navigate.

If you have concerns about scarring or other aspects of the surgery, your surgeon will be happy to discuss them during your consultation.