Rhinoplasty after Previous Septoplasty

Written by Frank P. Fechner, MD

Not uncommonly, patients come to see us for rhinoplasty who had septoplasty surgery performed previously in order to improve breathing difficulty. This septal straightening procedure may have been performed as part of a rhinoplasty, nasal fracture repair, sinus surgery or as a stand-alone procedure. It is important that the person interested in rhinoplasty informs the plastic surgeon about the previous procedure. Why? Because during a septoplasty, parts of cartilage and bone may have been removed which limits the remaining support of the nose. (I have seen patients who developed severe nasal collapse after over-aggressive septal surgery). In addition, additional cartilage for grafting may be necessary for the rhinoplasty to be fully successful. If the surgeon is surprised by missing cartilage during the rhinoplasty procedure, other sources (usually the ear) may provide the needed material and it is, of course, best to prepare this beforehand. Often, a careful examination by the rhinoplasty surgeon will show how much septal structure has been changed or removed during previous septoplasty.
Certainly, performing septoplasty and rhinoplasty as one procedure is best for the patient and this would be my preference. Because of the intricate relationship between septum and outer nasal appearance, staging the two procedures is suboptimal.