A septoplasty can certainly be combined with a rhinoplasty. The operation is rather common and is called septorhinoplasty. Many of them occur because a patient who has come to their cosmetic surgeon for a rhinoplasty, or “nose job” discovers that they have a deviated septum. They then opt to have both the shape of their nose and their septum corrected at the same time. Another good thing about septorhinoplasty is that a patient’s insurance provider is more likely to cover it, since it is not only cosmetic but helps improve the patient’s breathing. Often, people born with a deviated septum do not know that they are not breathing correctly. It is simply the way they have always breathed!
About Septorhinoplasty
A patient who has a septorhinoplasty is usually under general anesthesia, and the surgery itself lasts about two hours. The patient can spend a night in the hospital or the operation can be an outpatient procedure. If it is an outpatient procedure, the patient must have someone drive them home, and stay with them for about a day to help them with household tasks.
There are two main types of septorhinoplasty. They are opened or closed. These techniques are further subdivided depending on the needs of the patients. In an open operation, the columella between the nostrils is cut and the skin and tissue peeled back a bit to expose the inner structures of the nose. To keep the nose symmetrical, the surgeon may also make incisions right at the sides of the nostrils. In a closed procedure, the surgeon operates inside the nose. The incisions can’t be seen in the closed procedure, but even in the open procedure the incision usually heals so well that there is very little scarring. The doctor and the patient decide on the best technique to both give the patient the nose they seek and correct problems with their septum.
To correct the septum, which is the thin wall of bone and cartilage between the nostrils, the doctor may need to use a graft of bone or cartilage. The graft may be taken from the patient’s ears, hip, rib, skull or elbow or even from the septum itself. Doctors also use artificial implants.
What Happens Before Septorhinoplasty?
Unlike an emergency operation, preparation for a septorhinoplasty can begin weeks before the actual operation. First, the patient must stop smoking if they do. Smoking increases the risk of complications during and after the surgery and interferes with healing. The doctor may also tell the patient to stop taking certain medicines and even herbal supplements some time before the surgery. Some medications and supplements act as anticoagulants, which can interfere with blood clotting.
Just before the surgery, the patient has tests such as X-ray, blood test and even an ECG to make sure they are still a good candidate for the septorhinoplasty. They should feel free to shower or bathe before they come in for surgery, wear loose clothing and not wear jewelry. The patient should fast for at least six hours before the operation. The surgery will have to be postponed if the patient has a cold or other respiratory infection.
When the patient comes into the clinic, they will speak with the anesthesiologist. This medical professional will tell the patient about the type of anesthesia they will be having.
After the surgery, the patient is moved to a recovery area where they can be monitored for a while. The medical staff checks their blood pressure, breathing, pulse and surgical wounds to make sure that all is as it should be. The doctor may order supplemental oxygen for the patient while they are recovering. The patient may feel nauseated after the operation, but they can be given a medication to ease their nausea.
The doctor will have splinted and packed the patient’s nose after the operation, and the patient may feel stuffed up after they return home. Despite this, they must not forcefully blow their nose or do any strenuous activities for at least a month. The doctor will prescribe painkillers and antibiotics.
One tip for a patient who has had a septorhinoplasty is to keep their head elevated, even while they sleep. They should pile their headboard with pillows to achieve this. They should also apply ice packs to reduce the swelling. A good schedule for this is 10 to 30 minute sessions about four or more times a day during the first two days after the operation. The ice packs can be applied less and less after this. Moist heat helps with discomfort after the first two days.
The doctor removes the splint over the patient’s nose a week after the surgery. If the patient has had an open septorhinoplasty, the doctor takes out the stitches about five days after.
The patient will notice a blood-tinged discharge from their nose for the first days after their operation. This is normal, but call the doctor if the nose starts to bleed heavily and unstoppably. The patient must avoid smoking and alcohol. It is best that they stay home from work for at least 10 days.
The patient shouldn’t drive for at least two days after the surgery and arrange to have someone drive them around if this is necessary. Indeed, some insurance companies might not cover the surgery if they discover that the patient has driven before 48 hours after their surgery.
Gradually, the nose changes in appearance until it assumes its new shape. This takes about a year, but most septorhinoplasty patients not only enjoy the look of their new nose but are happy to be able to breathe the way they should.
If you are interested in septorhinoplasty, call Dr. Rubinstein at the Hudson Valley Sinus Center
Dr. Ran Y. Rubinstein is a board-certified ENT doctor and rhinoplasty specialist in the Hudson Valley area. He is a fellow in the American Academy of Otolaryngic Allergy and a member of the American Academy of Rhinology and the American Society for Laser Medicine and Surgery
