Septoplasty and Nasal Reconstruction

While a nose that looks good brings balance and harmony to  the face, it should not be at the sacrifice of breathing.  Patent and functional nasal passages are a  vital part the nose.  The inside of the  nose should be as nice as the outside.   Often many Plastic Surgeons have very little to no training on  functional nasal surgery so even if they happen to create a cosmetically  appealing nose, they may neglect to fix the inside or worse yet, create new  problems on the inside of the nose.

Nasal Reconstruction Washington DC - Front View BeforeNasal Reconstruction Washington DC - Front View After

The inside of the nose and the outside of the nose are  intimately connected.  The nasal septum  on the inside is the structural wall and foundation of the external nasal  architecture.  Think of the nose as a  building.  The septum is the support  inner wall while the outside of the nose is roof.  You cannot have a straight roof with crooked  walls!  Therefore is a naïve Plastic  Surgeon fails to recognize or diagnose a deviated septum prior to Rhinoplasty,  then he may actually create or worsen the appearance of a crooked nose.  The old saying amongst Facial Plastic  Surgeons is “Where goes the septum, so  goes the nose!”

While the septum provides a source of cartilage for grafts  during Rhinoplasty, its own structure is important.  A crooked septum often must be straightened  during a cosmetic Rhinoplasty.  However,  not all patients have a deviated septum.   Slight deviations are very common and perfectly straight septums are  rare.  Often patients wonder is insurance  will cover some or all of the Rhinoplasty if there is septal deviation.  In most situations, the two parts of the  procedure are billed separately.  A  cosmetic Rhinoplasty is not billed to insurance.  Insurance may cover a small portion of the  surgeon’s fee as well as part of the anesthesia and hospital fees.  But ethically and legally the cosmetic  portion should not be billed to insurance.   However if there is a true and problematic septal deformity then  insurance should hopefully cover that portion of the surgery.  Enlarged turbinates may also create nasal  airway obstruction.  Turbinates are the  humidifiers of the nose and they fluctuate in size during the day.  They even alternate from side to side in a  process called the “nasal cycle.”  While  the turbinates may be trimmed, they should not be over aggressively reduced or  completely removed.  This type of  aggressive turbinate reduction, commonly done in the past, leads to atrophic  rhinitis also known as empty nose syndrome.   It’s quite a problematic functional internal nasal deformity that is not  easily fixable.

Nasal Reconstruction Chevy Chase, MD - Side View BeforeNasal Reconstruction Chevy Chase, MD - Side View After

Vestibuloplasty also known as spreader grafts can widen the  internal valve area just above the nasal tip and below the nasal bones and  improve nasal airflow.  Alarplasty with  alar rim grafts or alar batten grafts can provide strength and support to the  nostrils and lessen or prevent dynamic inspirational nasal collapse.

Nasal reconstruction is more for reconstruction of the nose  after MOHS skin cancer removal or trauma resulting in nasal tissue loss.  Various techniques can be used including  local and regional flaps.  Some are done  in one stage while others may require several surgeries for optimal  results.

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Dr. Naderi went on to train above and beyond completing a fully accredited fellowship in Facial Plastic & Reconstructive Surgery with Dr. Stephen W. Perkins, one of the world's top cosmetic Facial Plastic & Rhinoplasty Surgeons and a past president of the American Academy of Facial
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Plastic Surgeon Dr. Shervin Naderi is a member of an exclusive & highly specialized group of Board Certified Facial Plastic Surgeons who have dedicated their surgical practice and expertise to helping those who are looking to improve their appearance and quality of life
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Rhinoplasty & Cosmetic Surgery Washington DC
Dr. Naderi is exclusively a face specialist.
He is a clinical instructor for Allergan and Medicis, in addition to having his own courses teaching other Dermatologists and doctors how to properly inject Botox/Dysport and Dermal Fillers.
*Rhinoplasty is surgery and all surgeries have potentially significant life threatening risks but when performed by a specialist in the proper settings, the risks are reduced.
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