Deviated Septum / Septoplasty

What is a Deviated Septum?

Many people have septum issues where the cartilage has been slightly damaged or no longer divides the two nasal passages equally. However, a deviated septum occurs when significant changes have happened. The septum collapses or deviates enough to partially or completely block one or both airway passages. This can cause problems with breathing but also impacts sinus drainage. Those with a deviated septum are prone to sinus infections and other respiratory issues.

What Is the Relevant Anatomy for a Deviated Septum?

There are various components of the septum, such as:

• Septal cartilage
• Ethmoid bone
• Vomer bone
• Maxillary crest

Each of these components may contribute to a deviated nasal septum.

Who Is a Good Candidate for Septoplasty?

Not all patients with a deviated septum require septoplasty surgery or treatment. It is important to consider the degree of septal deviation and if the symptoms correspond to the objective findings on examination. For example, someone with reduced nasal breathing on the left side, all the time, and a septum that is deviated to the left may be a good candidate for a deviated septum surgery. However, a patient with an intermittent nasal obstruction that jumps from one side to the other and a slightly deviated septum to one side is likely not a good candidate for septoplasty surgery. Each situation is different and must be critically assessed so that patients get the correct nasal septoplasty treatment.

Studies estimate that about 10% of the global population suffers from nasal congestion. One major reason for nasal congestion is a deviated septum, which exists in 40-60% of the population. Not all deviated septums require surgery. In fact, the majority of these issues DO NOT need to be surgically corrected. Properly advising patients on who would benefit from surgery, and what the best surgical approach is, is extremely important.

There a several reasons beyond nasal breathing obstruction to consider a deviated septum treatment, such as:

• Bleeding – A deviation may expose part of the septum to dry air and cause bleeding episodes.
• Facial Pain – A condition called Sluder’s Neuralgia can be caused by a deviated septum impinging on nerves inside the nose.
• Sleep apnea – Studies have shown better tolerance of sleep apnea masks after nasal septoplasty, though the sleep apnea itself is unlikely to improve.

What Are the Types of Surgical Approaches for a Septoplasty?

There are two main types of approaches to septoplasty surgery, which are:

• Closed – The most common type involving an internal incision to expose the cartilage.
• Open – A less common choice for deviated septum surgery which involves making an incision on the outside of the nose (hidden at the columella) and the inside. This more advanced approach is useful when the front part of the septum (caudal septum) badly deviates and a more extensive septoplasty procedure is required.
• Endoscopic – Some septoplasty surgeries can be performed with a minimally invasive endoscopic approach. This approach works well for a posterior-based septal deflection where an incision towards the front of the nose can be avoided.

How Is a Septoplasty Performed?

To restore balanced nasal passages, a deviated septum is repaired through septoplasty. This nose surgery requires repairing the cartilage and creating two balanced, equal nasal passages to restore open passageways. The cartilage is shaped and moved as needed, adding stents or cartilage in some cases.

To be more specific, the five major steps of septoplasty surgery NYC  include:

• Anesthesia – Once the patient is under general anesthesia, 1% lidocaine with epinephrine is used to provide local anesthesia mainly to shrink the blood vessels to reduce bleeding during the procedure.
• Incision – The septoplasty incision is made either through a closed or open approach as described above.
• Dissection – A plane right over the cartilage is used to expose the cartilage and adjacent bone posteriorly and inferiorly, being extra cautious not to create any rents in the flap of tissue that is raised off of the underlying structures. Rents can predispose to septal perforations (hole in the septum).
• Removal – Once full exposure is obtained, the deviated segment of cartilage and/or bone is removed. Most importantly, a sufficient amount of septal cartilage is left in place to prevent the collapse of the nose. If an open approach is used and a septal reconstruction planned then a segment of cartilage is removed, reoriented and supported, and placed back into position.
• Closure – Once the septum is straightened the incision is closed. Internal nose splints are sutured into place to hold the cartilage and tissue flaps (mucopericondrium) together. Packing is rarely needed.

Dr. Gary Linkov, at City Facial Plastics in UES, Manhattan, is a highly experienced facial plastic surgeon who offers septoplasty to restore the shape and function of the nasal passages. Although this is not a cosmetic procedure, some patients opt to also have a rhinoplasty (nose reshaping) performed with their septoplasty to improve the shape and aesthetics of their nose. Dr. Linkov performs septoplasty alone or with cosmetic changes, based on the patient’s preferences.

If you have a deviated septum that is causing breathing or sinus difficulties, contact City Facial Plastics in Manhattan’s Upper East Side today. We will schedule an appointment for you to meet with Dr. Linkov for an exam and consultation to discuss septoplasty and nose repair.

How to Prepare for the Septoplasty?

In preparation for deviated nasal septum surgery, the following information is helpful:

• Avoid certain medications and supplements that may thin the blood
• Stop smoking at least 2 weeks before surgery, as tobacco products can decrease blood flow to the skin and compromise the healing of the surgical site
• Stop all nasal sprays 2 weeks before surgery, except for saline which you can continue

What to Expect on the Day of the Procedure?

Do not eat or drink 6 hours before your scheduled surgery. Septoplasty surgery is performed under general anesthesia with an anesthesiologist present. There will be no pain during the surgery and you will have no recollection of the procedure. Your time at the private operating room suite or the ambulatory surgery center will be about 5 hours, with 2-3 hours of actual surgical time.

What Is the Recovery From a Septoplasty?

During septoplasty recovery, the nose will be stuffy for the first few days to weeks. There may be light bleeding from the nose for the first 48 hours, rarely is it more severe. The internal nasal splints are removed at the first follow up appointment at 1 week postoperatively. It is important to avoid strenuous activity such as exercise or heavy lifting for at least 1 week postoperatively.

What Are the Risks and Complications of a Septoplasty?

Risks and complications of a deviated septum nose job septoplasty, include:

• Bleeding
• Infection
• Poor scarring
• Undesirable aesthetic result
• Upper dental numbness
• Persistent or relapse of deviation
• Septal perforation (hole in septum)
• Saddle nose (bridge collapse)
• Persistent nasal congestion
• Decreased sense of smell
• Septal hematoma (blood collection)

What Are the Contraindications for Septoplasty?

There are patients who should not have a septoplasty, these include patients with the following:

• Health conditions that would make surgery dangerous
• Active infection
• Recent cocaine use
• Children with underdeveloped cartilage
• Large septal perforation
• Unrealistic expectations

Are Septoplasties Worth It?

Data suggests a septoplasty satisfaction rate of about 85%. Deviated septum surgeon Dr. Linkov has found that the number is higher in his practice mainly due to optimizing patient selection. It is critical to recommend the appropriate surgery to the right patient and to select the correct approach.

Is a Septoplasty Covered by Insurance?

Most deviated septum surgery is covered by insurance. Keep in mind that certain septoplasty doctors are not in-network providers. Many insurance policies have out-of-network coverage which may apply. As long as the septoplasty surgery NYC is performed in the proper ambulatory surgical center then the facility and anesthesia fees are almost always covered by in-network coverage.

Who Performs Septoplasty?

Septoplasty, or deviated septum, surgery is performed by top plastic surgeons or facial plastic surgeons. In selecting a surgeon make sure to ask about all of the possible septoplasty approaches to make sure that you are getting the most customized care.

Who Is the Best Deviated Septum Surgeon in NYC?

Dr. Gary Linkov is a board-certified facial plastic surgeon in NYC. Dr. Linkov is a busy septoplasty and rhinoplasty surgeon with extensive experience treating all conditions of the nose. He is the  Chief of Otolaryngology and Facial Plastic Surgery for the Veterans Hospital in Brooklyn, NY, where he operates on complex nasal deformities, serving our country’s veterans. Dr. Linkov’s private practice in Manhattan, NY focuses on cosmetic and functional septoplasty and rhinoplasty.

Septoplasty Before and After

If you have any questions for the best-in-class facial plastic surgeon in New York City, Dr. Gary Linkov, or would like to make a septoplasty consultation, please feel free to contact our City Facial Plastics office, located in Midtown, Manhattan for a consultation.

Dr. Linkov is a double board-certified by the American Academy of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology-Head & Neck Surgery. A native of New York, Dr. Linkov graduated as a salutatorian from Cornell University and received his Medical Degree at Columbia University College of Physicians and Surgeons. Dr. Linkov conducted advanced head and neck cancer research at the world-renowned Memorial Sloan Kettering Cancer Center. Dr. Linkov is a former Adjunct Assistant Professor at New York University (NYU), where he taught Rhinoplasty.

Dr. Linkov is a top-rated facial plastic surgeon in New York who specializes in lip lift, facelift, rhinoplasty, and hair transplant. He has been named one of the top 5 lip lift surgeons in the United States, is listed in the prestigious SuperDoctors New York™ registry, and has appeared on the Dr. Oz Show, where he discussed the state-of-the-art hair transplantation procedure.

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