Will Revisional Rhinoplasty Make Me Breathe Better?

Q: Dr. Eppley, I may need a revisional rhinoplasty? I did not have breathing problems before I had a rhinoplasty? When I went back for a six month follow up I was told I had a deviated septum and needed more surgery. I was told I did not have one before surgery but that it has grown back that way now. Could the rhinoplasty have caused the deviated septum? Or was the deviated septum there before and it was just missed during the initial rhinoplasty?

A: One of the most common reasons for revisional rhinoplasty surgery is nasal airway obstruction. A recent published study of revisional rhinoplasty reported that up to 70% of patients had some degree of airway obstruction and was a main motivating factor for the surgery. There are many potential causes of breathing problems after rhinoplasty of which a deviated septum is but one. Usually, however, a deviated septum is diagnosed before or during the initial rhinoplasty and only ‘recurs’ because it was inadequately corrected. If there were no breathing problems before surgery, it would be unlikely that a deviated septum has developed now. With cartilage graft harvest, presuming that was done, septal deviation is less likely to occur.

One of the most common causes from the initial rhinoplasty is if osteotomies or breaking of the nasal bones was done, particularly if a low-to-low or even a low-to-high osteotomy pattern was done. A low initial starting point for the osteotomy can partially close down the airway. Another common reason is collapse or pinching of the middle vault which narrows the internal nasal valve, a critical point for airway passage in the nose. Both of these sources of nasal airway obstruction come from the common aesthetic manuever of taking down a hump or bump in the nose particularly if it is large. This can cause collapse of nasal structures which have to be recognized during the initial procedure to enable preventitive manuevers to be done.

The short answer to your question is that there may be other causes of airway obstruction besides a deviated septum that must be taken into consideration.

Dr. Barry Eppley

Indianapolis, Indiana