Q: Dr. Eppley, lastyear ago I had a septoplasty to correct a severely deviated septum that resulted from a broken nose when I was a teenager. My surgeon removed a sizeable bone spur that was obstructing my breathing and that improved it a lot. Unfortunately, it did little to correct the aesthetic appearance of my nose. The septum is still very deviated midway up the nose so it has maintained its crooked appearance. Furthermore, my right nasal bone is caved in slightly.When I consulted a plastic surgeon a recently about the possibility of a revision of the prior procedure, he said it would not be worth it considering a lot of cartilage was removed. This would make it hard to re-anchor/attach the septum and would also increase the risk of perforation. What can I do to fix this asymmetry? Is a rhinoplasty still possible?
A: A septoplasty, in and of itself, will rarely make a significant change in the correction of a deviated or asymmetric nose. This is because deviation of the nose is a multi-factorial problem that is caused by aberrant anatomy than involves more nasal structures than just the septum. While it is true that a secondary septoplasty will be difficult due to scar tissue, there is no way to really know beforehand if it will be a good source of cartilage for the rest of the rhinoplasty. I have found more times than not that there is still some cartilage to be harvested. When combined with ear cartilage, there will be enough graft to so a more complete septorhinoplasty procedure. I would still approach your nasal concerns as a correction of the entire anatomy of the nose rather than camouflage techniques such as injectable fillers.
Dr. Barry Eppley