Raffy Karamanoukian, MD
Rhinoplasty Expert Los Angeles

Before & After Photos

Click to See More Photos

Improving Breathing with a Septoplasty to Correct a Deviated Septum


Rhinoplasty is one of the most technically difficult procedures in plastic surgery, partly because of the importance of proper presurgical planning and partly because of the meticulous attention needed to deconstruct and reconstruct the nose during surgery.  In practice, there is a lot of information that can be obtained from the initial consultation and examination. One of the most important and often neglected aspects of rhinoplasty surgery has to do with how well a patient can breathe before surgery. 

Dr. Karamanoukian has expertise in the cosmetic aspects of rhinoplasty and the medical benefits of septoplasty. Septoplasty is often performed in order to improve or maintain breathing after rhinoplasty. Septoplasty can be performed alone or in combination with a rhinoplasty.  If you have already undergone a rhinoplasty and are having some difficulty breathing during the day, with exertion, or during sleep, you may be a candidate for a septoplasty or airway correction during your revision rhinoplasty.

Common Causes of Airway Obstruction and Breathing Problems Needing Septorhinoplasty

The four most common causes of airway obstruction that are seen in our office are as follows:
  1. Deviated Septum ( The cartilage of the nose is warped and crooked).
  2. Scar Tissue ( Scarring inside the nostril can cause the airway to be narrowed).
  3. Turbinate Hypertrophy ( Allergic or inflammatory increase in the size of the turbinates).
  4. Trauma ( A broken nose can cause the bone to be crooked or collapsed).
There are many reasons why nasal breathing may be impaired.  Breathing problems can result from an obvious problem such as trauma or a broken nose, but can also occur from problems that can only be identified by close inspection of the inside of the nose.  Nasal breathing can be improved with septoplasty, where the nasal septum is trimmed down during surgery; or through other rhinoplasty techniques that open up the nasal airway and restore the normal breathing circuit. 

One common cause of nasal breathing problems is allergic rhinitis or allergic inflammation of the internal mucosa and turbinates of the nose.  If this is the case, there are surgical and non-surgical alternatives to minimize the source of inflammation, swelling, and blockage.  Breathing problems can also occur as a result of a curved or deviated septum inside the nose.  If a deviated septum exists, the airway blockage can be corrected by removing or trimming the area of deviation. 

A more difficult breathing problem is one that is caused by a previous rhinoplasty.  During rhinoplasty, the nose is often made smaller and trimmed down.  During the procedure, overaggressive rhinoplasty may cause some of the supportive cartilage and bone of the nose to be destroyed or collapsed.  A collapsed nose, tip, nostril, or nasal bridge may obstruct the normal breathing axis and lead to snoring, difficulty breathing, or even excessive tiredness and fatigue. 

If you have had a previous rhinoplasty, it is important for Dr. Karamanoukian to gauge the degree of vestibular stenosis, in which the nostrils and internal mucosa are blocked by scar tissue.  The degree of scar formation is usually associated with the amount of nostril narrowing and airway obstruction.  Vestibular stenosis is a condition that comprises the opening to the nasal airway by closing off or narrowing the nostrils.  This is not a condition that always necessitates surgery, but options are available with Dr. Karamanoukian in order to reduce the degree of nostril narrowing and vestibular stenosis with or without major surgery.  Patients who have scarring within their nose may be candidates for this type of nasal correction. 

Given this perspective, Dr. Karamanoukian will begin your consultation by assessing your history and performing a medical examination directed at your external nose, cartilage, bone, and septum.  Examination of the nose will reveal whether there is any benefit from a rhinoplasty, a septoplasty, or septorhinoplasty.  The decision to perform these procedures depends on the degree of nasal obstruction. 

Symptoms of a Deviated Septum or Nasal Obstruction Requiring Septorhinoplasty
  1. Nasal Congestion or Inability to breathe through the nose ( One side or Both sides).
  2. Nosebleeds.
  3. Sinus infections, chronic headaches, chronic congestion.
  4. Snoring or mouth breathing during sleep.
  5. Crooked nose.
There are many clinical signs and symptoms of a deviated septum or nasal obstruction.  Some of these symptoms require a septoplasty or rhinoplasty, and some can be managed conservatively with allergy medications and observation.  Some patients may not even know that their symptoms are caused by nasal congestion or obstruction.  If you experience chronic symptoms, you may benefit from a septoplasty or septorhinoplasty, depending on the severity of the nasal obstruction.  If you only develop symptoms during peak allergy seasons or during a cold, you may be a candidate for septoplasty, but may benefit from a trial of conservative therapy first. 


Recovery after Septoplasty Surgery

In most cases, patients who have undergone rhinoplasty or septoplasty will recover within one week of their surgery.  Rhinoplasty patients are typically active within one or two days. Dr. Karamanoukian will provide you with a recommended recovery regimen.  You should plan to remain at home with your head elevated the first night of surgery.  Thereafter, you will begin to notice a decrease in swelling and pain that decreases significantly day after day.  Ice packs and rest are recommended. 

Minor bleeding from the nose and swelling are common after rhinoplasty and septoplasty.  You will also experience some congestion of the nose coupled by bruising along the cheek and eye areas.  We suggest that you refrain from touching your face, engaging in any contact sports or strenuous activities until your nasal splints are removed.