Rhinoplasty and Septal Perforation Repair

About Dr. Jason Hamilton

Jason S. Hamilton, M.D. is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute based at Cedar-Sinai Medical Towers. Dr. Hamilton has advanced training in plastic and reconstructive surgical techniques involving the face, head, and neck, and limits his practice to the treatment of these areas exclusively.

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Is it appropriate to combine rhinoplasty and septal perforation repair procedures?

Question: A few months ago I suffered a nasal fracture while playing baseball with some friends. At the time, I had my nose “reset” in the emergency room. I followed up with the ENT doctor three weeks later and was diagnosed with a septal perforation.  I have begun to notice a whistling noise during normal breathing as well as increased dryness of my nostrils. As time passed my nose did begin to heal but it eventually collapsed in on itself and now has a large indentation which my doctor calls a “saddle-nose deformity”. My doctor suggested that the septum perforation caused my nose to collapse and that I should have a septal perforation repair procedure. Can I have a rhinoplasty and a septal perforation repair done together?

Discussion:

Combining reconstructive rhinoplasty and septal perforation repair procedures is not only appropriate but often times encouraged. Since the patient is already under anesthesia and many of the same nasal structures are manipulated in both procedures, it is advantageous to address both functional and cosmetic concerns at the same time. Likewise, scarring and manipulation of delicate structures is also minimized with one procedure, allowing the surgeon to shape the nose once, not having to revise its structure again later. This combined approach effectively eliminates the time spent waiting between two traditionally separate procedures. Furthermore, expense is also substantially decreased during a combined approach.

While rhinoplasty is often incorrectly considered strictly a cosmetic procedure, it is also performed to address functional and reconstructive concerns. Nasal fractures oftentimes debilitate the structural integrity of the nose. These frequently unaddressed or ignored changes not only lead to potentially unwanted cosmetic changes but also possible functional concerns such as obstruction of the nasal passages and collapse of nasal support structures.

Figure 1: Side view of the normal internal structures of the nasal cavity.
Figure 1: Side view of the normal internal structures of the nasal cavity.
Figure 2: Frontal view of the nasal passages depicting a septal perforation.
Figure 2: Frontal view of the nasal passages depicting a septal perforation.

Septal perforation is a common consequence of trauma to the nose. The nasal septum serves as the main support structure of the nose; if a perforation is large enough, this support collapses and the nose develops an indentation commonly referred to as a “saddle-nose deformity”. While there are temporary treatments available such as septal buttons (Silastic rubber plugs), surgical repair is considered the only permanent and appropriate treatment for larger perforations and coinciding saddle-nose deformities. Septal perforation surgical repair procedures typically carry a low rate of success due to recurrence of perforations and rejection of grafts. The Osborne Head and Neck Institute is renowned for its near flawless success rate and relief of symptoms.

Dr. Jason Hamilton, Director of Plastic and Reconstructive Surgery at the Osborne Head and Neck Institute, is double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology/Head and Neck Surgery. His extensive training and expertise provide him with a unique perspective to address both functional and cosmetic concerns of the nose.  Dr. Hamilton has pioneered a revolutionary method of septal repair that does not employ the use of grafts and which he can combine with rhinoplasty to further strengthen, reshape, and define the overall framework of the nose.  Dr. Hamilton holds an unprecedented 99% success rate in septal perforation repair procedures.

Key Points:

  • Combining rhinoplasty and septal perforation repair procedures is not only appropriate but often times encouraged.
  • While rhinoplasty is often times considered a cosmetic procedure, it is also performed to address functional and reconstructive concerns.
  • Septal perforation is a well-known and common consequence of trauma to the nose. The nasal septum serves as the support structure of the nose; if a perforation is extensive enough this support  collapses and the nose develops a dip commonly referred to as a “saddle-nose deformity”
  • Dr. Jason Hamilton is trained in both otolaryngology and facial plastic and reconstructive surgery, placing him in a unique perspective to address both functional and cosmetic concerns of the nose.
  • Dr. Hamilton holds an unprecedented 99% success rate in septal perforation repair procedures.

For more information on rhinoplasty and septal perforation repairs please contact the Osborne Head and Neck Institute.