A Quick Guide to Sinus Surgery
Septoplasty and Breathing Difficulties
During your consultation at Dr. Rizk’s New York office, he will determine if your septum is significantly deviated, whether your turbinates are considerably enlarged and how a reduction would improve your breathing. In addition, Dr. Rizk will use a 3D high-definition telescope to observe and evaluate other nasal conditions including polyps and nasal obstruction which may affect your breathing. Dr. Rizk may recommend doing a CT scan in some cases to further analyze polyps or sinuses, as well as testing for allergies.
Initial treatment will include medications that are supposed to decrease the nasal tissue, such as antihistamines and nasal steroid sprays, or antibiotics if a sinus infection is detected. When this treatment fails, Dr. Rizk may recommend performing a septoplasty, sinus surgery, and/or turbinate reduction.
Endoscopic septoplasty is a procedure done from inside the nose to correct the nasal septum and it does not involve breaking the nose. Dr. Rizk does not use packing, as was commonly used in the past. This considerably decreases swelling and recovery time. He sometimes uses nasal tissue glue in place of a pack.
In addition, should a chronic nasal obstruction, such as a nasal valve collapse be present, then immediate treatment is required. Nasal valve collapse may be caused by trauma to the nose, prior rhinoplasty procedures, and other factors. Sometimes, nasal valve collapse can be treated by lifting the cheek tissue on the side of the nose that is obstructed. Special nasal strips may also be used. However, in some cases, these measures will not suffice, and surgery may be required.
Real Patient Results
26 year old female with a long nose and drooping tip shown preoperative and 6 months after surgery. Patient sent her own picture 2 years after the surgery as a followup.
23 year old female who underwent open rhinoplasty with grafts and alar base reduction. The patient has thick skin making this procedure an ethnic rhinoplasty. The nasal bridge and alar base was slimmed down to better compliment her facial features.
26 year old female shown 1 WEEK after nose surgery and septoplasty. Patient had an endoscopic rhinoplasty to shave a bump as well as tip refinement with sutures and tip graft to support the nasal tip and prevent postoperative tip drop. Patient also had a septoplasty to correct nasal obstruction. Note patient is obviously still swollen but still with swelling, can be presentable in a week after procedure.
Latino female in early 20’s who underwent endonasal 3d rhinoplasty and nostril reduction. Patient had thick skin and poor tip support which was addressed during the nose surgery. Patient sent her own picture 3 years after the procedure as a followup.
32 year old female with previous history of rhinoplasty who complains of a pinched asymmetrical nasal tip and difficulty breathing. Patient has also thin skin. Patient underwent revision septorhinoplasty with cartilage grafts and fascia to nasal tip so soften its appearance. Patient is shown 1 year after revision rhinoplasty.
She is 10 days after open rhinoplasty and alar base reduction.
Female patient who had an Open Rhinoplasty. Photos shown here are 6 weeks after surgery.
17-year-old female underwent rhinoplasty to remove bump, deproject and slightly lift tip, all done through endonasal approach. Patient is shown 1 year after surgery.
Our patient 6 months after her rhinoplasty procedure. I did an open rhino to lift her drooping tip. I also removed bump to contour and create a more pleasant tip in addition with neck liposuction..
Rhinoplasty to address bump removal, droopy tip, and deprojecting nose. Patient is shown 1 year after open rhinoplasty.
Female patient who had a Primary Rhinoplasty. Photos shown here are 6 days after surgery. Bump Removal, Tip Refinement, Lifting hanging tip, narrowing bridge and tip. Patient still swollen.
55 yo patient shown 10 years after revision 4th rhinoplasty with rib bank cartilage. ( she had come back for rhinoplasty on her teenage daughters 10 years later !!)
Concurrent Functional Endoscopic Sinus Surgery and Rhinoplasty
Over the past decade, the advent of endoscopic sinus surgery using the Messerklinger technique, which restores the natural drainage of the sinuses, has resulted in more effective and less radical sinonasal surgery . Moreover, the increased utilization of computed tomography (CT) scanning in the management of sinusitis has led to more precise localization of sinus anomalies. These advances have made the simultaneous procedure safe and efficacious in appropriately selected patients with sinusitis. The purpose of this report, by Rizk SS, Edelstein DR. Matarasso A, is to identify the indications and limitations of the simultaneous procedures.
How Is an Internal Nasal Valve Collapse Treated?
An internal nasal valve collapse may be treated by placing strips of cartilage in the collapsed area, or through the reattachment of cartilage to the septum. Alar batten grafts may be used if the collapse is caused by weakness in the nasal sidewall. In some cases, the surgeon may choose to combine alar batten grafts with a septoplasty procedure, or with cartilage harvested from the ear or elsewhere. In other cases, septorhinoplasty with alar batten grafts may be more suitable.
Some patients who have had previous rhinoplasty procedures may need revision septorhinoplasty with ear cartilage grafts and batten grafts. Again, it all depends on the patient’s particular circumstances. Speak with your rhinoplasty surgeon for more information on treating nasal obstruction caused by a nasal valve collapse.
Sinusitis and Sinus Surgery
1 in 10 Americans5 suffer from sinusitis, a chronic condition in which the sinuses are blocked and do not drain properly. Repeated infections develop and patients experience difficulty breathing, pressure, headaches, and excessive drainage from the front of the nose (rhinorrhea) or back of the nose into the throat (post-nasal drip).
If you catch a cold or have an allergy attack and it lingers for more than a week, it can often be related to sinusitis6. The nose collects mucus, and within a few days, the sinus passages swell and block the airways. The mucus then starts to build up within the sinuses, causing the symptoms described above.
Other causes of sinusitis are polyps, a deviated nasal septum, or narrowing of nasal drainage pathways. When there is a specific anatomical blockage that does not respond to medicine, a CT scan is recommended. If it shows the etiology of sinusitis, surgical drainage may be the only effective alternative. Functional endoscopic sinus surgery (FESS) in combination with medications and allergy treatment can improve breathing and alleviate sinusitis symptoms.
How is sinus surgery done?
Functional endoscopic sinus surgery is done by inserting small telescopes connected to a monitor with a high-definition camera system to visualize the narrowed or blocked sinus openings. Micro-instruments are used to enlarge the natural sinus openings into the nose. The word functional is used in the procedure name because the procedure enlarges the natural sinus openings and does not create new openings. Sometimes, a three-dimensional CT-guided system is used to visualize all the sinuses and surrounding structures on a computer screen for additional precision.
Does sinusitis recur? Can polyps come back?
Sometimes, if an allergy is severe, polyps or sinusitis may recur. This is why it is important to control the allergy with medication or allergy shots in order to prevent or delay the recurrence of these conditions. A condition called the Aspirin triad is when the patient is allergic to Aspirin and has asthma and polyps. With this Aspirin triad condition, the polyps tend to recur more rapidly.
What conditions can an endoscopic sinus surgery correct?
Dr. Rizk performs endoscopic sinus surgery to correct sinus problems (namely sinusitis) as well as breathing problems. Depending on the patient’s needs, Dr. Rizk may use a method known as the Messerklinger technique to restore natural drainage, functional endoscopic sinus surgery (FESS) to improve breathing, as well as other techniques.
Before having endoscopic sinus surgery, many patients visit several doctors to determine the cause of their sinus problems. An allergist may check for any allergies that could be contributing to the problem, and antihistamines or nasal steroid sprays may be prescribed. An otolaryngologist (ear, nose, and throat doctor) may examine you to see if you have issues such as a deviated septum or swollen turbinates. These issues can be treated through surgery or other treatment methods.
If these and other measures are unsuccessful, you may be a candidate for endoscopic sinus surgery. Contact Dr. Rizk to learn more about endoscopic sinus surgery.
Septoplasty with Turbinoplasty
In some cases, patients that have a deviated septum3, where inside the nose one side is bigger than the other, can also experience large turbinates as they tend to adjust themselves by getting bigger as well. As a result, the blockage of airways worsens. In these situations, septoplasty surgery combined with turbinate reduction is required in order to improve your breathing as well as the level of sinus drainage.
What is a Deviated Nasal Septum?
A deviated nasal septum or “crooked” internal nose can occur at childbirth or as the result of an injury or other trauma. If the wall that functions as a separator of both sides of the nose is tilted towards one side at a degree greater than 50%, it might cause difficulty breathing.
A deviated nasal septum can also worsen sleep apnea, a breathing disorder that makes your breathing repeatedly start and stop during your sleep. Signs of sleep apnea are loud snoring, episodes of stopped breathing during the night, daytime sleepiness, etc.
Ethmoidectomy and Maxillary Antrostomy
The ethmoid sinuses4 are located between the upper eye toward the eyebrows and the bridge of the nose and drain into the nose. The maxillary sinuses are the cheek sinuses, which drain into the nose as well. These are the main places that need to be cleaned from all sinus infection and well-drained since all other sinuses drain through the ethmoid sinuses, using them as a passageway.
If this area is blocked, the infection can migrate/expand to other sinuses. Ethmoidectomy is a surgery in which Dr. Rizk removes the infected tissue and bone in the ethmoid areas that block natural drainage. Maxillary antrostomy is a surgery in which Dr. Rizk opens or widens and cleanses diseased tissue or polyps from the maxillary sinus opening. These procedures are done with telescopes from inside the nose. Occasionally the sinus infection may involve the frontal or sphenoid sinuses as well and they may require cleaning and opening.
Risks Associated with Septoplasty, Turbinoplasty, and Sinus Surgery
Septoplasty, turbinoplasty, and sinus surgery can greatly improve patients’ quality of life. However, there are some potential side-effects and risks associated with these procedures. These include:
- Small chance of infection
- Bruising and swelling during the recovery
- Turbinate asymmetry
- Visible scarring
Dr. Rizk examines each patient individually and builds an aftercare plan tailored to your specific case. This will help minimize potential side-effects and increase your chances of a successful outcome.Book an Appointment
Dr. Rizk believes:
“It’s better to focus on a few plastic surgery procedures and do them exceptionally well than to do all types of plastic procedures, all over the body, badly. My practice is highly specialized in the nose and face only – sort of a specialist within a specialty of plastic surgery.
A beautiful nose is a natural one that compliments and fits harmoniously with a patient’s face. I do not believe in a universally ideal nose, only an ideal nose for a particular face.
I believe the nose is one of the most artistic parts of one’s face and cultural differences should be respected in changing a nose; I don’t like upturned, scooped out, or excessively pointy noses.
I have pioneered techniques to give you a natural nose with tiny hidden incisions and a rapid recovery. Every nose that I do is different as every face is different and a customized, individualized approach describes my techniques.”
Septoplasty, Turbinoplasty, and Sinus Surgery Recovery Tips
Recovering from surgery is different for each patient. While some patients experience minimal discomfort and return to their daily activities relatively quickly, for others, aftereffects such as swelling can persist for months. If you are planning on having septoplasty surgery, your recovery will depend on a number of factors, including your unique anatomy and what actions you and your facial plastic surgeon take.
Immediately After the Surgery
Immediately after your procedure, your nose will probably be sore, and you should expect some bruising. You may feel a bit nauseated as well. Your surgeon and his or her staff will monitor you at the surgical facility for two or three hours. In some cases, patients need to remain at the facility overnight. Once you have been cleared to leave the facility, a friend or family member will need to drive you home.
Here is an approximate breakdown of the septoplasty recovery period:
Immediately following surgery, as mentioned above, you may be sore following surgery and will need to stay at the surgical facility until you are cleared to go home. You will need to rest with your head elevated for a couple of days.
Two days after surgery: Any surgical packing will be removed. However, note that the best facial plastic surgeons have special techniques that eliminate the need for surgical packing.
Two weeks after surgery: Swelling should subside somewhat and you may be able to resume most of your everyday activities. (Some swelling will persist for a matter of months and up to a year.)
One month after surgery: Your nose should be completely healed, but there will still be some swelling.
What to Avoid
For at least two weeks prior to your surgery, you should avoid blood thinners including aspirin, ibuprofen, fish oil, garlic, herbal teas, Ginkgo Biloba and St. John’s Wort. Inform your surgeon of any medications or herbal supplements you take so that he or she can advise you. If you feel stuffed up don’t take over-the-counter decongestants, because some of them contain drugs that can make bleeding worse. Instead, ask your doctor what you should take.
Alcohol should be avoided for two days prior to and two weeks after your procedure, as it will exacerbate swelling and bleeding.
Avoid smoking at all costs — both before and after surgery — as it can have an extremely negative effect on your recovery and healing.
Also, avoid moving your head too much for the first few days after surgery. You should avoid wearing glasses for a few weeks. Do not engage in any rigorous activities for several weeks. Do not engage in contact sports for several months (ask your surgeon when you will be ready).
Written Patient Testimonials
Dr. Rizk and his staff were absolutely incredible! They made me feel so comfortable throughout this entire process and I am so grateful for everyone (especially Dr. Rizk) for helping me look the best version of myself. My nose looks natural and perfect and I am in love with the results!!! If you are on the fence, I definitely encourage you to come to this office because Dr. Rizk gave me the confidence and grace to present myself to the world!
Words cannot express how tremendously grateful and impressed I am for his services. The process was painless and he produced beautiful results that I’m so happy with. Dr. Rizk is extremely precise, patient and detail orientated. He narrowed my nose 1mm at a time! I’m already looking forward to my next small tweek with him.
Fixed my nose that was extremely crooked from a car accident. Also did my brother’s nose which case out beautifully
I had a rhinoplasty/septoplasty with Dr. Rizk and couldn’t be more pleased with the results! He is an extremely talented surgeon who made me feel entirely at ease during the whole procedure. Not only has my breathing improved, but he constructed a beautiful nose for me. I also found the members of his staff comforting-Dila was wonderful! I couldn’t recommend this practice more. There is no need to look any further!
After consulting with two other surgeons, I selected Dr. Rizk to correct a deviated septum, a turbinate reduction and polyps removal. I am pleased to say that I am happy with the outcome of my surgery. In addition, I felt welcomed and respected from the moment I walked through the door.
Today makes it 5 weeks to the day that I had a Rhinoplasty and Septoplasty by Dr. Sam Rizk. I am extremely happy, pleased, amazed with the results. Not only can I breath better, my nose looks amazing. The best part is, it looks natural!!!!! I can’t say enough about Dr. Rizk and his staff Rosemarie, Dila, Heidi, Tatyana, Danielle and the anesthesiologist, everyone is extremely friendly and professional.
Once you have healed from the rhytidectomy you can expect to see the results that you desired, and your satisfaction will have you feeling radiant. Dr. Rizk’s facelift surgery results are long-lasting. His patients are consistently amazed at their natural-looking results.
1 American Society of Plastic Surgeons. Septoplasty. Available: https://www.plasticsurgery.org/reconstructive-procedures/septoplasty. Accessed January 26, 2021.
2 Jaimanti Bakshi and Sourabha K. Patro. Septorhinoplasty: Our Experience. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581764/. Accessed January 26, 2021.
3 WebMD. Deviated Septum. Available: https://www.webmd.com/allergies/deviated-septum#1. Accessed January 26, 2021.
4 Medical News Today. What to know about ethmoid sinusitis. Available: https://www.medicalnewstoday.com/articles/327517. Accessed January 26, 2021.
5 CDC/National Center for Health Statistics. Chronic Sinusitis. Available: https://www.cdc.gov/nchs/fastats/sinuses.htm/. Accessed January 26, 2021.
6 Healthline Media. What You Need to Know About Sinusitis. Available: https://www.healthline.com/health/sinusitis. Accessed January 26, 2021.
7 Annals of Plastic Surgery. Available: https://journals.lww.com/annalsplasticsurgery/pages/default.aspx. Accessed January 15, 2021.
By Dr. Sam S. Rizk, M.D., FACS.
Dr. Rizk is a double board-certified facial plastic surgeon who specializes in rhinoplasty surgery and a recognized expert on the latest advances in facial plastic surgery techniques. He performs a range of facial plastic surgeries at his New York practice.