Septoplasty

Septoplasty

Dr. Thomas Lamperti, double board-certified in both Facial Plastic and Reconstructive Surgery and Otolaryngology (Ear, Nose, Throat surgery), is an expert in treating all areas of nasal dysfunction and has performed thousands of nasal surgical procedures. This includes addressing functional symptoms such as chronic nasal congestion, sinusitis, allergies, and skin cancer reconstruction along with cosmetic nasal concerns. Septoplasty, surgical treatment of the deviated nasal septum, is one of the cornerstones in improving functional breathing issues.

Things to know about having a Septoplasty:

• What is the nasal septum?
• How the septum becomes deviated
• How the septum can affect breathing
• What septoplasty involves
• How long septoplasty takes
• Septoplasty anesthesia
• No packing needed after septoplasty
• Insurance coverage for septoplasty
• Septoplasty recovery
• Septoplasty risks
• Having a concurrent rhinoplasty
• Turbinate surgery to fix nasal congestion
• Having concurrent sinus surgery

Where is the nasal septum?

The nasal septum is the dividing wall inside the nose that separates the nasal cavity into its two sides. The septum is made up of cartilage in the front of the nose and a thin sheet of bone toward the back of the nose and is then covered by a skin lining layer on both sides. To get a better idea of what the septum is you can watch this video to see what the inside of the nose normally looks like, including a straight septum.

How a deviated septum develops

[Base view of deviated nasal septum before and after septo-rhinoplasty] The septum can become deviated as result of the normal nasal growth process or, more commonly, from nasal trauma. The patient on the left suffered several nasal fractures which resulted in the deviation of her nose and septum, including her anterior septum. This caudal septal deviation is what causes the patient's asymmetric nostril size in the photo.

A deviated septum can be diagnosed by having a comprehensive nasal exam. Importantly, the more easily seen anterior septum may be straight, but the harder to examine posterior septum may be significantly deviated. This is one reason that Dr. Lamperti routinely assesses the entire nose using a small endoscope.

How can a deviated septum cause congestion?

Very few people have a perfectly straight septum, but more significant deviations of the septum can lead to a reduction in nasal airflow and the sensation of congestion.

What does septoplasty surgery involve?

Septoplasty typically involves making a small incision on the inside of the nose on one side. Learn more about the septoplasty incision here. This allows Dr. Lamperti to elevate the skin lining off of the deviated cartilage and bone of the septum. The misaligned cartilage and bone is then removed which allows Dr. Lamperti to sew the skin lining back to itself using a quilting type suture. All the sutures used are dissolvable and come out on their own. With the deviated cartilage and bone removed the skin lining is able to lay much straighter which then allows for smoother airflow when breathing. You can see a video of a septum before and right after septoplasty here.

Occasionally, in more complicated deviations, a small external incision is also used to allow for complete reconstruction of the septum. This was the approach used in the patient shown above.

Septoplasty surgery typically takes about 30 minutes. Of course, more complicated cases can take longer.

Septoplasty surgery is done in the operating room. Either IV sedation or general anesthesia can be used. Once this anesthesia has been administered, Dr. Lamperti injects local numbing medicine that will last a couple hours. Surgery is done as an outpatient procedure;  you are able to go home once you have recovered from anesthesia.

Is nasal packing used during septoplasty?

Dr. Lamperti does not typically use packing after septoplasty surgery. Instead, he uses dissolvable sutures to ensure that the septum heals correctly. Occasionally, Dr. Lamperti will use a thin plastic splint inside the nose to prevent scar band formation. This splint is removed one week after surgery.

Is septoplasty covered by insurance?

Septoplasty is medically covered surgery and is typically covered by insurance. If you like, Dr. Lamperti's office can find out if septoplasty is covered under your insurance.

How long is septoplasty recovery?

Septoplasty recovery is usually 2 to 3 days and can often occur over a weekend. The recovery for more extensive septoplasties or septoplasty done in conjunction with rhinoplasty usually takes about 7 days.

What are the risks of septoplasty?

The risks of septoplasty include the risks of any surgery such as bleeding, infection, reaction to the anesthesia, injury to surrounding structures. Risks specific to Septoplasty include persistent congestion or asymmetric breathing. There is also a rare chance of a hole developing in the septum (septal perforation) during the healing process. Even more rare risks are that of injury to the smell organ or spinal fluid leak. Dr. Lamperti limits his manipulation of the upper boney portion of the septum to avoid injury to the smell organ or bone of the skull base and has never had this complication occur in his practice.

Can I have a nose job during my septoplasty?

The time of your septoplasty is an ideal time to have a rhinoplasty to reshape your nose. Dr. Lamperti often uses portions of septal cartilage during rhinoplasty surgery to create the planned changes in the nose's appearance. The cartilage removed during an isolated septoplasty is otherwise left out of the nose, making it more difficult (though not impossible) to perform rhinoplasty in the future.

Can surgery on the turbinates be done at the same time as septoplasty?

The turbinates are out-pouchings of tissue that come off of the side of the nasal cavity and act as the radiator of the nose. They help to humidify and warm the air we breathe through our nose. Sometimes the inferior turbinates become chronically overgrown and contribute to the blockage of nasal airflow. This can be addressed during your septoplasty. Dr. Lamperti usually debulks the internal components of turbinate tissue using a small access incision at the very front of the turbinate. This maintains the normal turbinate skin lining which helps reduce problems of postoperative crusting.

What about having sinus surgery along with a septoplasty?

Sinus surgery can be done at the same time as septoplasty. The decision to perform sinus surgery is based on a patient's symptoms and findings on sinus CT scan. It is important to understand that sinus surgery itself will not affect nasal airflow.

Can septoplasty help with my snoring or sleep apnea?

Improving nasal breathing can, in certain situations, help with symptoms of snoring or sleep apnea. This occurs as you are able to do less mouth breathing while sleeping. Septoplasty is not a cure-all, however, and may not affect your sleep symptoms at all. Dr. Lamperti can assess your situation during your consultation to let you know whether nasal surgery has a chance of improving your sleeping issues.

Meet Plastic Surgeon, Dr. Lamperti

Dr. Lamperti, a Seattle rhinoplasty super-specialist, has devoted his career to treatments of the head, face and neck. He feels that by focusing his plastic surgery endeavors solely to the face he is best able to provide the excellent results his patients desire.

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