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Board Certifications: American Board of Facial Plastic and
Reconstructive Surgery American Board of Otolaryngology - ABO

Deviated Septum

Situated in New York City, Dr. Rizk is highly experienced in correcting a deviated septum. The septum is the soft cartilage area of the nose that separates the left and right nostrils, and is particularly vulnerable to dislocation. Dislocation can occur due to a congenital disorder or as a consequence of physical trauma to the nose. As well as contributing to nasal asymmetry, differences between left and right nasal anatomy can affect breathing and increase susceptibility to infection. Most people with deviated septa are not aware of it until certain nasal issues indicate a problem. Some of these issues include congestion, pain, nasal discharge, and problems with the ability to smell.

Deviated septum repair, known as septoplasty, is a surgical procedure designed to straighten the crooked cartilage and improve airflow into the sinuses. In patients where sinus infection is common, this procedure often drastically reduces the frequency of infection. It can also be used to correct problems associated with nosebleeds, snoring, sleep apnea, and may be a necessary procedure for other surgeries that require entrance into the nose. Contact our office in NYC if you suffer from any of these issues, so our doctor can determine if they are caused by abnormalities in the nasal septum.

Septoplasty is performed while the patient is under general anesthesia, with the entire procedure typically lasting between one and two hours. The tissue lining of the septum is gently lifted from the underlying structure, allowing our doctor to view the cartilage and bone deformities directly. Using small instruments, he will shift the cartilage into place or remove certain obstructive areas, depending upon which method he feels will result in the best outcome. To hold the septum in its new and proper place, small splints are flanked and stitched to the sides. The incision sites are then sutured together.

After surgery you may experience minor congestion and headaches, and there may be discomfort associated with the temporary splints. Antibiotics are prescribed to prevent infection, and you will be instructed to maintain proper cleansing of the sinuses. Increased mucous discharge is normal and will disappear once the nose has healed. Any related pain can normally be safely alleviated with medication. Take care to sneeze through the mouth to avoid putting pressure on the nose, and avoid any activities that may stress or disturb it. Contact our office if there is excessive bleeding or if you have any other concerns. In a week's time, you will be required to return to have your nose re-examined by our doctor, at which point he will remove the splints, which will relieve much of the discomfort that you may be experiencing.

Our doctor is one of a few board-certified facial plastic surgeons located in NYC. He has developed many techniques that have improved the efficacy of facial surgeries. A specialist in nasal treatments, our doctor will determine whether a deviated septum is the source of your issues and discuss the specifics of the septoplasty procedure with you. If you decide to undergo a septoplasty, he will provide you with additional information about the surgical protocol to ensure you will have a safe and effective operation. A deviated septum is a problem that can be easily fixed and drastically improve your quality of life.

Deviated Septum FAQ

What is a deviated septum?

What is a deviated septum? The septum is the long strip of cartilage tissue that separates the two air passageways of the nose. A deviated septum refers to an asymmetry in this area, which may or may not be visible on the surface. Often times, a deviated septum can be the cause of health complications, but sometimes no health repercussions occur due to the condition.

What causes a deviated septum?

Deviated septums are often congenital, meaning that they originated at birth. This could be due to a genetic predisposition, or a development that happened during the fetal growth process. The other common cause of deviated septa is trauma to the nose. Whether from a fall, accident, or contact sport, the nose's position on the face makes it vulnerable it to physical damage and possible dislocation. A deviated septum is not a disease, but rather a condition that describes an asymmetry of the nasal passages.

What's the problem with a deviated septum?

Sometimes nothing. Hardly anyone has a perfectly straight septum, but for some, this asymmetry can cause a variety of problems and/or be aesthetically undesirable in some people. A deviated septum disrupts normal airflow through the nostrils, which may result in breathing problems. Although this can be avoided by breathing through the mouth, such disruptions in airflow may also increase an individual’s susceptibility to sinus infections. Other issues may include snoring, problems sleeping, and frequent bleeding.

How can I tell if I have a deviated septum?

If you can't tell and you don't experience any of the aforementioned health issues, then there is little need to be worried about a deviated septum. If, however, you are experiencing health issues or cosmetic concerns that you feel may be related to a deviated septum, you should contact Dr. Rizk’s office in New York to schedule a consultation.

How is a deviated septum fixed?

The surgical procedure designed to correct a deviated septum is called septoplasty. Dr. Sam Rizk makes a series of incisions within the nasal cavity to expose the underlying tissues. Parts of the cartilage may be excised and thinned in order to remove obstructions. The septum is then repositioned and held in place by dissolvable sutures and splints.

How long does the surgery take?

Septoplasty generally takes less than two hours. Patients will be under general or twilight anesthesia for the duration of the operation. If you are undergoing an outpatient procedure, you should arrange for a friend or family member to take you home after the surgery. You may experience the lingering effects of anesthesia for the next day or two; during this time, you should not operate heavy machinery.

What is the recovery time?

Full recovery typically takes several months. Breathing through the nose will be limited at first; therefore strenuous exercises should be avoided during the first few weeks. Splints will be removed after the first week. Prescription or over-the-counter medications can help alleviate any pain and discomfort.

Are there risks associated with the surgery?

The risks associated with septoplasty include infection, reaction to anesthesia, and bleeding. Septoplasty is a very safe procedure and is known to drastically improve nose function. In rare instances, perforations may form along the septal tissue, resulting in possible discomfort or additional problems.

What will happen to the appearance of the nose?

Dr. Rizk takes the aesthetics of the nose very seriously when planning any nasal surgery. All septoplasty procedures should restore both the function and original appearance of the nose.

Can I have my nose's appearance improved during a septoplasty?

It is possible to combine septoplasty and rhinoplasty (a surgical cosmetic enhancement to the nose) into a single operation; however, rhinoplasty procedures demand a different skill set and approach, thus the procedures should not be combined solely for convenience. Only your doctor will be able to determine if cosmetic changes can safely be made in conjunction with a septoplasty.

Does insurance cover septoplasty?

Many insurance plans do cover procedures to correct a deviated septum. If you choose to combine it with a rhinoplasty that portion of the operation is unlikely to be covered. Schedule a consultation in Dr. Sam Rizk's office in NYC to learn more about deviated septum and whether a septoplasty is the appropriate treatment.

Deviated Septum – General Information

A deviated septum is a medical condition characterized by improper airflow through the sinuses as a result of a crooked or asymmetric nasal septum. The septum, which is made up of a layer of skin and cartilage that separate the nostrils into two chambers, helps channel air into the sinuses for the purpose of cleansing, warming, and humidifying. People who suffer from a deviated septum are more prone to snoring, sinus infections, nosebleeds, and even sleep apnea. A deviated septum can be corrected permanently with surgery.

Deviated septa can occur as a result of trauma, congenital defects, or more rarely, certain medical conditions. While no septum is perfectly straight, extreme hindrance of airflow through the nasal passageways will lead to frequent congestion, inflammation, and infection. This may affect your quality of life greatly, as breathing through the nose can be more difficult and often irritating. Septal surgery, also known as septoplasty, is a common and safe surgical procedure that will reposition the septal wall at the mid-line of the nose and restore symmetry to the nasal passageways. Patients report being able to breathe through the nose much more easily after surgery and typically report decreased occurrences of sinusitis.

Incisions are made entirely within the nostrils so there will be no visible scaring. Most patients heal very well and find that their airflow obstructions are permanently resolved through septoplasty. An endoscope (a small flexible tubular camera) will be used to visualize the inside of the nostrils before the operation. The entire procedure will last under two hours and you will be under anesthesia the entire time. The procedure is generally done in an outpatient center, so you should arrange for a friend or family member to take you home. Do not attempt to drive a car or operate heavy machinery while recovering from the effects of anesthesia.

The surgery involves separating the mucous lining and skin tissue from the cartilage of the septum. A variety of sanding equipment and grafts may be used to properly shift and reposition the septum to restore symmetry. After these adjustments, the overlaying tissues are placed back over the cartilage and stitched with dissolvable sutures. Splints may be used to hold the position in place as the body heals. These will be removed within the first two weeks after surgery.

As with any invasive operation, there are risks associated with septoplasty, including infection, adverse reaction to anesthesia, or surgical error. While perforation of the septum is rare, such occurrences have been reported. If you experience discomfort or a whistling noise when breathing through the nose after the healing phase, contact your septoplasty surgeon, as this may point to a septal perforation. You may be advised to adapt a nasal irrigation regimen after surgery to keep your nose and sinuses clear of bacteria and quicken the healing process. If you experience dizziness or develop a fever after surgery, call your doctor immediately, as this may be a sign of infection. Be sure to tell your doctor about any medications you may be taking and whether it is safe to take them before or immediately after surgery. Avoid any sports or exercise that may damage the nose during the healing period. Full recovery time may range between six months to a year.

Septal Perforation FAQ

Patient before and after rhinoplasty *Results may vary. View More Photos
Patient before and after rhinoplasty side view *Results may vary. View More Photos

What is a septal perforation?

A septal perforation is the presence of a hole or gap in the nasal septum, the soft cartilage area that separates the two nasal passageways.

How does a septal perforation occur?

There are a variety of ways in which the nasal septum can become perforated. Physical trauma, such as one received from a sporting injury, could cause a hole to form in the septum. In other cases, a septal perforation is the result of a nasal surgery, such as a septoplasty (to repair a deviated septum) or a rhinoplasty (a surgical cosmetic enhancement of the nose). The hole could also be a result of dying cartilage tissue, which could be brought on by a variety of diseases or chemicals snorted through the nostrils (e.g. cocaine). In rare cases, cancer can also lead to a septal perforation. Receiving a nose ring is an example of a self-inflicted a septal perforation.

What kinds of problems does a septal perforation cause?

Patients with septal perforations may hear a slight whistling sound when breathing through the nose. It can also cause general pain and discomfort, and can become a site of frequent infections. Patients have reported symptoms including bleeding, crusting, and breathing irregularities as a result of septal perforations. If left unattended, these holes may grow bigger, causing problems to become more severe.

What can be done about it?

Keeping good hygiene is the first and often the only step needed for patients with minor problems associated with a septal perforation. The nostrils should be frequently cleansed with saline solution to prevent bacterial and debris buildup. A gel is also recommended to maintain the nasal environment and prevent excessive crusting of the mucous membranes. If the hole is larger and/or causes problems such as serious infections or collapse of the nose structure, surgery may be required.

How is surgery to repair a septal perforation performed?

If the hole is small enough, sutures may be enough to close up the hole. If the hole is larger, tissue grafts must be required. The grafts may be obtained from the patient’s ear or rib, and then used to fill in the hole by attaching the grafts to the surrounding tissue. Operations to correct a septal perforation pose a particular challenge because the end result is difficult to predict. There is no guarantee that blood flow will return to the nasal structure, and such nutritional deprivation may result in recurring perforation. Another method to restore proper airflow involves covering up the hole from both sides using a small prosthetic button, however this approach requires long-term care to maintain the prosthesis, so is often less desirable.

How long will it take to recover after a septal perforation repair surgery?

Dr. Rizk is able to visualize the nose in high definition using his advanced 3D cameras. By using minimal incisions within the nose and avoiding large blood vessels, he is able to significantly cut down recovery times for septal perforation operations. Patients may return to work within a couple of days, and the nose should completely heal within a month.

I might have a septal perforation, what should I do?

Schedule a consultation with Dr. Sam Rizk to discuss your concerns. Dr. Sam Rizk is double-board certified plastic surgeon with extensive experience in addressing problems of the nose. His office in NYC is easily accessible by car or public transportation.

Written by Dr. Sam Rizk

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