Many people live with a deviated septum, a condition where the thin wall of cartilage and bone separating the nasal passages is crooked. This significantly restricts airflow and causes chronic breathing difficulty. When this functional problem is paired with a wish to alter the external appearance of the nose, the question arises: can both issues be addressed in a single procedure? The answer is generally yes. A specialized surgical approach exists to correct the structural issue while simultaneously refining the nose’s shape, providing a comprehensive solution to both the internal obstruction and external aesthetic concerns.
Defining Septoplasty and Rhinoplasty
The distinction between the two primary nasal surgeries lies in their purpose. Septoplasty is a purely functional procedure designed to correct a deviated septum and improve breathing. The surgeon works internally, reshaping or removing bent cartilage and bone to restore proper nasal airflow. Because the work is done inside the nose, septoplasty typically does not alter the external shape or appearance.
Rhinoplasty, often called a “nose job,” focuses primarily on aesthetic enhancement. This procedure alters the size, shape, and proportions of the nose to improve facial harmony. While rhinoplasty can sometimes include minor functional improvements, its core intent is cosmetic. This difference is significant because functional procedures like septoplasty are often considered medically necessary and may be covered by health insurance, whereas aesthetic rhinoplasty is an elective surgery.
The Combined Procedure Septorhinoplasty
When a patient has both a breathing problem from a deviated septum and aesthetic concerns, the solution is septorhinoplasty. This single operation simultaneously addresses the deviated septum and the external shape of the nose. Performing both corrections at once is generally more effective and safer than undergoing two separate surgeries.
The technical demands of this combined surgery are complex because the septum is the central support structure for the nose. Straightening the septum and harvesting its cartilage for grafting requires careful planning, as this cartilage is often necessary for aesthetic reshaping. Surgeons frequently use the straightened septal cartilage to create structural grafts, such as spreader grafts or columellar struts, to reinforce the nose and maintain the improved airway. This structural reinforcement prevents external changes from compromising the functional breathing pathway.
If the native septal cartilage is insufficient due to severe deviation or previous surgery, the surgeon may need to harvest autogenous cartilage from other areas, such as the ear or rib. Rib cartilage is considered the gold standard for major reconstruction due to its strength and volume. The septorhinoplasty technique allows for the refinement of the nasal tip, shaving down a dorsal hump, and narrowing the nasal bones, while ensuring the internal airway remains clear and structurally sound.
Balancing Functional and Aesthetic Goals
Pre-operative planning for a septorhinoplasty begins with a comprehensive consultation. The surgeon performs a detailed physical examination, often including an endoscopy and sometimes a nasal computed tomography (CT) scan. This imaging helps map the internal structures and identify the extent of the septal deviation and other potential airway obstructions, such as turbinate hypertrophy.
The consultation also involves discussing patient expectations for the aesthetic outcome, often utilizing digital imaging to simulate potential results. The surgeon’s primary responsibility, however, is ensuring the functional result is never compromised by cosmetic desires. The priority is always to establish a patent and stable breathing pathway. Aesthetic changes must be carefully balanced with the integrity of the nasal structure to prevent future breathing issues like nasal valve collapse.
Post-Operative Recovery and Results
Recovery from a septorhinoplasty involves healing from both the internal and external procedures. Immediately after surgery, patients typically have external casts and internal splints or packing to support the repositioned septum and nasal bones. Swelling and bruising around the eyes and nose are common and are most pronounced during the first week.
While visible bruising and external splints are usually removed around one week post-surgery, the timeline for functional and aesthetic results differs. Patients often notice significant improvement in breathing once the internal splints are removed and initial internal swelling subsides, typically within the first month. The aesthetic result takes much longer because residual swelling can persist. Approximately 60 to 70 percent of the swelling resolves within the first three months, but the final, refined contour of the nose may take a full 12 to 18 months to stabilize.