Search for tag: "rhinoplasty"

Interviewer: You have a deviated septum. Should you get surgery to fix that?

Dr. Marc Error is an ENT at University of Utah Health. And Dr. Error, I'm going to go ahead and throw myself into this. I was in a doctor's office one time and they commented that, "Oh, you've got a deviated septum. Did you break your nose?" And I don't remember ever breaking my nose, but I definitely do notice if I push on one side and try to breathe, it's harder than the other side. Should I come see you and have that fixed?

Dr. Error: A deviated septum can definitely make it more difficult to breathe through one side or the other. The septum is the curtain between the left and the right nostril. And it starts at the very front and travels all the way to the very back of the nose where it ends and opens up into one big cavity. And if that divider is crooked at all, it can block off one nostril or even both if it has an S-shaped deformity to it. So, if you're having trouble breathing through your nose and that bothers you, absolutely, you should have that checked out because that is something that can be repaired and fixed and made so that you can breathe easier through both sides of your nostril.

Interviewer: So that was something I had never considered before. I do notice when I have allergies, so sometimes when I'm having allergies or have a cold, then it's really difficult to breathe through that right nostril. But I don't know, I mean, tell me a little bit about the surgery so I could weigh the pros and the cons. If I was to come into your office and give you the same scenario I just gave you, where would that conversation between us start?

Dr. Error: Well, first of all, we'd really need to assess what's going on completely with the nose. A deviated septum, which is what a septoplasty does and corrects can only be a piece of the puzzle. The nose is a complex organ that has many potential areas that can cause nasal obstruction. And you alluded to the fact that it does change. You know, when you have a cold or when you have allergies, you notice that it's even worse. And this is because there's other structures in the nose that are swelling and causing trouble. Those structures are called turbinates, much like they come from the Latin word turbine that have to do with mixing of air. And these are structures that we all have that are there to humidify air, but over time or if they become irritated, they can get too big and they can block your nose.

So, first of all, we'd really have to assess your nose and say, "What's contributing to your problem? Is it the septum alone? Is it the turbinates?" There's also some cartilages in the nose that can be a little bit weak or floppy. When you breathe in, it creates negative pressure and that can make it so that it's a little bit . . . if those cartilages don't hold the nasal soft tissues open, it can make your nose collapsed. And so these are things that we would take a look at and really assess, why are you having troubles through your nose?

Once we figure that out, the first line treatment for anybody with difficulty breathing through your nose and you included, Scot, would be using a nasal steroid spray regularly. Something like a Flonase or a Rhinocort or fluticasone. There are many that are over-the-counter. These are safe to use long term. They do have some local side effects where they touch or where you put them in the nose, where they can dry out the nasal linings and cause some nasal bleeding. So you have to watch for that, but these ones are safe to use long term.

They work by reducing inflammation in the nose. They don't change the cartilage and the structure of a deviated septum, but they can make it so there's less inflammation and there's more room for air to flow. These take a long time to work, three to four weeks at a minimum to really get the maximum benefit and many people, including myself, if we're to get throwing ourselves into this, I use it pretty regularly because my nose gets plugged, but I can use that and it opens it up enough that I do okay.

But if the nasal steroid spray is inadequate at helping you breathe better through your nose, at that point we'd explore interventions and invasive interventions to help you breathe better, such as a septoplasty or a turbinate reduction or a combination of those procedures to help you open up the nose and breathe better.

Interviewer: So, and my original thought here was, you know, the physician that I saw, this was just a very casual diagnosis, right? So it might not even be accurate, but it looks like you broke your nose. I've noticed that my right nostril seems smaller. I have difficulty breathing. Is that really even a deviated septum is causing that, or is that because I broke my nose and something else is going on?

Dr. Error: No, that is most likely a deviated septum. When you break your nose, you know, we discuss the nose as a complex structure. You know, it's complex three-dimensional structure. And if you break the nasal bones, that frequently will cause influence and may cause a shifting of the septum over to one side or the other.

Kind of a check to see if you have a deviated septum is just as you had mentioned, if one side is more plugged than the other. That usually is a sign that that septum is pushed over. And it tends to be that it's always one side or the other. Like you mentioned, your right side is usually worse than the left side. That's a sign of a deviated septum.

Now, a lot of people will have something where one side is always plugged, but it switches. It goes from right to left. And even if they lay down, they may notice that the side that's closer to the floor, we call it the dependent side swells shut, and if they flip to the other side, the other side swells shut. That's a sign of something else going on in the nose called turbinate hypertrophy or turbinate growth. The turbinates will switch from one side to the other, and those are predominantly treated with, as we discussed, the nasal steroid spray, but there's also procedures that can be done to shrink them down and make them smaller as well.

Interviewer: When somebody is in your office and you've weighed out all these particular options, is there like kind of a final thing that you'd like to say to them to, you know, give them to think about as they consider whether or not the surgery would be for them?

Dr. Error: Well, it really is just based off of, you know, how bad does this bother you? If it's on your mind at all and bothering you at all, you know, it's a week of some discomfort, but it's something that you get benefits for the rest of your life as long as you don't break your nose again. It also can help with some sleep issues if you notice that you're waking up and your nose is plugged. There are people that wake up and they have to get up and walk around until their nose decongest before they can fall back asleep. And so all those things, it can help and just improve your quality of life.

Interviewer: So you've decided to get a rhinoplasty. How long can you expect to see the results that you were hoping for?

Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: I'm here with Dr. Cori Agarwal. She is an associate professor of plastic surgery at the University of Utah Health. So, Dr. Agarwal, what can I expect right after surgery when I get my rhinoplasty?

Dr. Agarwal: So rhinoplasty is an outpatient surgery. And depending on how complex it is and all of the work that you're planning on getting, it can take a couple of hours under general anesthesia typically, and you would go home after that surgery the same day. Right after the surgery, you're going to have some bandages on and a splint on the outside of your nose that's going to be taped onto your cheek, sometimes taped onto your forehead. You may have some blood dripping from the nostrils and a gauze under there. So right after the surgery, you're not going to be looking your best. You'll go home and the main thing for the first couple of days is really to just take it easy and let things heal so that there isn't any bleeding or complications.

Interviewer: After the first few days, do the bandages come off? What's after those first few days?

Dr. Agarwal: So it depends a bit on how much work is done. If there's work done on the bones to narrow the nose or just on the soft tissues, so that'll vary a little bit. But, in general, I think, as a rule, most patients after rhinoplasty have a splint or a bandage on their nose for one week. So that's one week having a little cast on the outside of your nose where you're probably not going to want to be going out and doing a lot of social events. You want that splint to stay stuck on, so you don't want a lot of moisture on it. So that first week, I don't recommend making any plans.

Interviewer: So I assume there's going to be some swelling, and I assume there's going to be some discomfort. Is there anything during that first week or so that patients can do to kind of help speed up their recovery at all?

Dr. Agarwal: To minimize swelling, keeping your head elevated can help. And so what I ask patient to do, when they go home, is to get themselves kind of a nest to sleep in, where they have a few extra pillows behind their back or sleep in a recliner. Because when you lay flat, the swelling increases and you can . . . it's a little bit better if you keep your head elevated for those first couple of days while you go through the peak swelling time period.

Interviewer: And what about after those first few weeks? When does that splint finally come off?

Dr. Agarwal: So normally, between five and seven days, you'll go in for your follow-up visit with your surgeon, and they'll take the splint off, take out any stitches that need to come out. And at that point, you're going to be a lot more presentable. You will have still some swelling and possibly some bruising. You can have some bruising under your eyes sometimes, so you may need to put on some cover-up. But at that point, after one week, you can usually go back to work as long as you're not doing anything very strenuous or heavy lifting.

Interviewer: So once they take the splint off, is it just you're ready to go, like these are the results you wanted, or my understanding is that it takes a while?

Dr. Agarwal: Yeah. That's the thing that people don't always understand. And I really try to emphasize before the surgery to set the expectations. But the nose holds onto swelling longer than other parts of the body. And it's also right there in the front of your face. And so even a tiny bit of swelling you're going to recognize.

And so, usually, you're not going to look terrible after one week. But after a couple of weeks go by, the swelling is going to be very subtle to where mostly you're going to be noticing it or maybe some close friends or family would notice it. But it'll be a very small amount of swelling left after about three weeks. But that last bit of swelling, that last little bit takes about a year to go away. And so if you're looking for kind of that final best results of your nose, you have to be pretty patient.

Interviewer: A whole year? It's that last little bit of swelling. Why does the nose hold onto the swelling for so long?

Dr. Agarwal: That's just that the nature of the skin particularly on the tip of the nose can get boggy. Again, it's a very small amount of swelling, and it may not be too noticeable to the world. But when you're looking for your final result, it just takes that amount of time to see that final result.

Interviewer: So for patients that want to get a rhinoplasty, what's the one thing you would make sure to tell them to make sure that their expectations are where they need to be and that they'll be happy with the results?

Dr. Agarwal: So I think after the surgery, it's really important to make sure that you have . . . for the first week or so, you're in a healing period to make sure that you've set aside time off of work and that you have friends and family to help you out. And you'll slowly get back to normal between the first and third week. I think you're going to be feeling like yourself and you're going to be really happy with your new nose. And you do need to remember though that it may take a few months or even up to a year before you have your final result that you've been looking for.

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Interviewer: What to know if you're considering rhinoplasty to help your breathing. That's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Eric Cerrati is a plastic surgeon at University of Utah Health that specializes in cosmetic and reconstructive surgery of the face and the neck. If you have been considering rhinoplasty to help improve your breathing, we're going to answer the questions you might have right now. There are a couple of reasons why somebody might get one. One is because that they want to improve their appearance. But the other one is because maybe they have some sort of a breathing issue. So let's pretend I'm a person that has a breathing issue and I've come in to talk to you about rhinoplasty. What would you tell me as a patient at this point?

Dr. Cerrati: So there's a lot of different aspects to nasal obstruction. You can have, one, the very common one is a deviated nasal septum which is a divider inside your nose. It usually leads to unilateral nasal obstruction. But then other causes of nasal obstruction include like internal and external nasal valve collapse. And those are usually addressed more with the rhinoplasty approach than just an endonasal septoplasty.

Interviewer: All right. So rhinoplasty covers a certain particular type of breathing issue that you would have. If you have those other issues, there are other procedures?

Dr. Cerrati: Yes. Usually a rhinoplasty would correct, say, when you breathe in, if one side of your nose kind of collapses or doesn't have the support to maintain that negative pressure, rhinoplasty approach can help provide more support to the external nose.

Interviewer: All right. So beyond kind of what you just described, there are other factors that go into whether or not this would be the right procedure for my breathing problem and to know if I was a candidate.

Dr. Cerrati: So really, the best thing is a physical exam done by someone who's experienced. I would recommend, if someone's interested in a rhinoplasty or has nasal obstruction, to really go to someone who is trained in treating people with all the different types of pathology that could cause nasal obstruction.

Interviewer: And what kind of result could I expect after the procedure if I had some sort of a breathing issue?

Dr. Cerrati: So that's actually a good question. So the same way that you would have swelling on the outside of your body, say if you had a cut or a bruise or that sort of thing, you just have that same healing process and swelling that occurs inside of your nose. So a lot of times, right after the surgery, you don't necessarily have perfect breathing right away. Your inside of your nose has to undergo the same healing processes. So within a week or two and all that swelling has resolved, the goal is to have a more open airway bilaterally.

Interviewer: And generally, does it really kind of change a person's life? I mean, are they able to, at that point, breathe in a way that they haven't before ever?

Dr. Cerrati: That's the hope.

Interviewer: That's why you do what you do, right?

Dr. Cerrati: Oftentimes it has significantly improved. There is part of a nasal obstruction that can be more subjective but a lot of times, we do get a significant improvement.

Interviewer: And then if somebody has a procedure, how long does it take? You'd mention about the two weeks to start noticing some breathing improvement, but what about getting back to your life? So you go and you have the procedure, go back to work, that sort of thing.

Dr. Cerrati: Yeah. So most times, the initial recovery we tell people about a week. Usually you can have some bruising and swelling kind of externally on the face which will improve over the first week. A lot of times, you'll have a cast on your nose. Depending on what type of work you do, you may or may not want to be visible or back at work during that time. But by halfway through the second week or by the end of the second week, you're kind of back to all normal activities.

Interviewer: Got you. And then what about scars or any sort of external things that are going on after surgery? Are there any visible scars?

Dr. Cerrati: So there's actually two different approaches to rhinoplasty, one's an endonasal and one's the external rhinoplasty. So the endonasal is just all incisions inside the nose and we can address a lot of different issues with that approach. However, there are indications where an external approach is going to be better. That will involve a small incision right at the columella, right underneath the nose. It's really just a five or six millimeter incision. And after about two or three months of healing, that scar is completely invisible.

Interviewer: Got you. So really not much if anything at all, especially if it was done inside.

Dr. Cerrati: Right.

Interviewer: Yeah. You had mentioned briefly about looking for a doctor that has experience in this. Give me some more information as a patient how I could pick the right doctor for this procedure to make sure, because you're messing with my face.

Dr. Cerrati: Definitely. So I would recommend someone who is board-certified in

Interviewer: What to know if you're considering a cosmetic rhinoplasty. We'll talk about that next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Eric Cerrati is a plastic surgeon at University of Utah Health that specializes in cosmetic and reconstructive surgery of the face and neck. Dr. Cerrati, when a patient comes to you for a cosmetic rhinoplasty, what are some of the common things that they're trying to address or take care of?

Dr. Cerrati: So usually that's kind of grouped in two to three different categories. The first one is your patient who's never had a rhinoplasty before and is really trying to address maybe some family features of theirs that they want to alter, say like a bump on the nose or a wide nasal base or that sort of thing. The next group is probably someone who has had rhinoplasty in the past and as a result has had some scar contracture leading to some asymmetry, whether it's in the kind of the distal part of the nose or the nasal tip. And then the last group I would say that has . . . after rhinoplasty, you have nasal obstruction that kind of results from that, from the first surgery.

Interviewer: Got you. What about somebody who's just had a nose that's may have been dislocated through, I don't know what could happen, they got hit or something of that nature and now as a result the nose is crooked?

Dr. Cerrati: Oh no, definitely yeah. Traumatic injuries are definitely a common cause for having rhinoplasty surgery.

Interviewer: Got you. So what can you do with this type of surgery when it comes to when a patient comes in? Most of the time are you able to help address their issues, or are there some times you just really can't?

Dr. Cerrati: So a lot of times yes, we can get the symmetry back, get the nose back in the midline, and fortunately form and function kind of go hand in hand. So when we improve their breathing, we also improve the appearance of their nose. But then if it's a purely cosmetic case, where we're really just trying to alter the external appearance, I would say that patients need to be careful, that there are risks involved, and that you're trying to chase the perfect physical feature, it gets very difficult.

There are definitely patients that we tell them that we don't think it's the best idea to undergo surgery. One, if a patient's had a lot of nasal surgery and say that they're missing a lot of cartilage in their nose and would require big reconstructive case, if their nose is functioning fine and they can breathe out of both sides and that's really just a small physical feature that they're chasing, I personally don't think that's a great idea and I would not recommend surgery to that patient.

Another situation where I wouldn't recommend surgery is if a patient has unrealistic expectations or if there's something that I just won't be able to achieve a surgery.

Interviewer: So what are some of the common questions that you get when it comes to this type of a procedure that we haven't discussed so far?

Dr. Cerrati: So commonly, a lot of patients ask about a closed rhinoplasty or an endonasal rhinoplasty versus the open or external rhinoplasty. Usually patients, by the time that they're considering the surgery, have kind of googled and come across a lot of these terms. Endonasal rhinoplasty, you can address a lot of these features, external appearance, and even function with that approach. Usually when you start altering say the tip or really going for correcting fine asymmetrical issues with the nose, really an external approach gives you better visibility and allows you to really address the problem better.

Interviewer: And the internal one is more useful for . . .

Dr. Cerrati: You can still accomplish a lot of things. It's just harder to get to, say, the tip of the nose.

Interviewer: Got you. And what's the preferred method? Is it the internal version because you have less scarring, or what's the advantage of that over the external?

Dr. Cerrati: So for the patient, really they're pretty equal. It's really surgeon's preference in which way a surgeon's been trained in. Endonasal rhinoplasty was very popular say 10, 15 years ago, and most surgeons were trained that way back then. Now, kind of the external approach, the pendulum has kind of swung the other way and most surgeons now are doing the external approach. For the patient really, if your surgeon is comfortable with either approach, they can get you the same result either way. With the external approach, you do have a very small incision. However, I would tell patients that after two or three months that incision essentially heals and becomes invisible.

Interviewer: After a procedure, how long does it take to kind of get back to your normal everyday life, go back to work, that sort of thing?

Dr. Cerrati: So I tell all my patients that for the first week really to take it easy. You'll have a cast on your nose. A lot of times you'll have bruising and swelling around the eyes. At the end of that first week, the cast comes off, the bruising and swelling starts to resolve, and probably midway through the second week or the end of the second week you're really back to all your normal activities and feel pretty fine.

Interviewer: And after a procedure, a cosmetic procedure, how long do those results last? You had mentioned that sometimes things can change a little bit after you've had one and you might have to get another one. So explain that a little bit.

Dr. Cerrati: So hopefully the results last a lifetime, especially in the nose when you're addressing the underlying structures. What I see with the revision rhinoplasty is a lot of times if, say the first surgeon takes way too much of the structure of the nose, too much of the cartilage, then over time the nose will start to warp and you'll get scar contracture. And that can lead to asymmetry in the nose and also lead to breathing problems.

Interviewer: And if somebody comes in and they need additional support in the nose, how do you do that exactly?

Dr. Cerrati: So there's a couple different places where you can get extra cartilage in order to rebuild the different areas of the nose. A lot of times the most common is the nasal septum, the cartilage there itself. It's right there in the nose, and there's really no other extra incisions for the patient. Another common one is the ear, which you make a small incision in the back of the ear and really take out the cup portion of the ear. All the external structure of the ear is maintained, so there's no change in the form or the function of the ear. And then lastly there's the option of using rib cartilage. So where your rib comes around and connect your sternum, there's actually a section of cartilage there that can be used to rebuild the nose as well.

Interviewer: And when looking for the right doctor to do a rhinoplasty procedure, that would be really important. I'd imagine there's a certain level of trust that a patient wants because after all it is your face. It's the first thing everybody sees. How do you recommend finding the right doctor for that procedure?

Dr. Cerrati: So I'd recommend looking at your surgeon's training. Being board-certified by the American Board of Facial Plastic and Reconstructive Surgery or the American Board of Plastic Surgery is very important. There's a lot of different paths that people can get to in order to get that board certification. For myself, I did a five-year residency in head and neck surgery, just really concentrating on operating above the shoulders. And then I did an additional year fellowship sponsored by the American Academy of Facial Plastic and Reconstructive Surgery, just operating on the face specifically.

Interviewer: So it sounds like just have a conversation with the doctor you're talking about and just ask them, "What path did you take? What preparation did you use to get here?"

Dr. Cerrati: Absolutely, and ask him how many procedures they do and you'll get an idea of how comfortable they are and kind of what their background is.

Interviewer: Yeah, and then what about the personal relationship? Like if you feel a connection or you don't, is there anything you recommend on that? I know some doctors, if you don't feel the connection with the surgeon, you should maybe look elsewhere.

Dr. Cerrati: Absolutely. I mean, you have to be comfortable. If this person's going to be operating on your face and external appearances, it's very important that you feel comfortable. So no matter how good they are or how good their credentials are, the number one thing is you need to feel comfortable with that person.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: July 17, 2019
originally published: November 7, 2017