The role of septal surgery in cosmetic rhinoplasty

Abstract

Septoplasty is performed to resolve breathing problems, but it often becomes pivotal to correct external nasal deviation, representing a central step in rhinoplasty surgery. Even in patients with no functional problems, septal surgery may represent the best solution for obtaining a proper realignment of the external nasal pyramid. One-stage septorhinoplasty has become the standard of treatment for a deviated nose, hence septoplasty cannot be considered as a separate procedure to perform before or after rhinoplasty or as a partial operation subject to later revision. The aim of this article is to discuss the close relationship between the nasal septum and the aesthetics of the nose, and how a graduated surgical approach for the correction of septal deviations could affect the external deviated nose.

Keywords: Cosmetic rhinoplasty; Deviated septum; Septoplasty; Septorhinoplasty.

Fig. 1.

Patient with a twisted cartilaginous nasal dorsum as a result of high cartilaginous septal deviation.

Fig. 2.

a. Patient with a small defect of the dorsum of the cartilaginous septum after primary rhinoplasty; b. Postoperative view after filling the defect with patient's own cartilage.

Fig. 3.

a, b. Preoperative view of a patient with a bony-cartilaginous dorsal hump ("tension nose"); c, d. Postoperative view after resection of the hump and refinement of the anterior septal angle. Indirect change of the ala, nostril and nasal tip can be observed.

Fig. 4.

a. Deviated anterior septal cartilage; b. Right anterior septum tunnel; c. Multiple scores are made on the concave side; d. Straightening of the cartilage: the attached contralateral mucoperichondrium flap helps in the straightening process.

Fig. 5.

a. A cartilage carving on the convex side is combined with a multiple cutting on the concave one; b. A weakening and straightening effect on the cartilage is obtained.

Fig. 6.

Through-and-through suture above and beneath the deviation, securing the knots on the convex side. This procedure, combined with weakening process, stabilizes the new position of the septum.

Fig. 7.

a. Deviated septal cartilage on the maxillary crest; b. Anterior superior and anterior inferior tunnel; c. Midline repositioning of the septum; d. Fixed cartilaginous septum by sutures to the nasal spine.

Fig. 8.

a. Cartilaginous resection on the fractured site; b. The preservation of the contralateral mucoperichondral flap, together with the fixation using through-and-through sutures, stabilizes the mobile pieces of the cartilage. c, d. Unstable fractured cartilaginous fragments resulting from the bilateral mucoperichondral flap and the absence of fixating sutures.

Fig. 9.

a. Twisted dorsal septum with asymmetric upper lateral cartilage; b, c. Separating the upper lateral cartilage on the convex side; d. weakening the cartilage by scores and carving on the cartilage; e. Realignment of the septum; f, g, h. A redundant upper lateral cartilage is removed (not always required).

Fig. 10.

a. Preoperative view of a patient with a deviation of the caudal septum and almost complete obstruction of the left nostril. b. Postoperative view of the same patient after correction of the caudal septum.

Fig. 11.

a. Patient with a prominent anterior septal angle and adjacent caudal edge of the cartilaginous septum; b. Dotted line: resection area of anterior septal angle; c. Postoperative view after resection of the anterior septal angle, an upward rotation of the nasal tip can be observed.

Fig. 12.

a. Patient with a blunt naso-labial angle and downward rotation of the tip. b. Dotted line: resection area of the nasal spine together with adjacent caudal edge of the septum; c. Postoperative view after resection of the caudal edge of the septum and the nasal spine, as well as resection of the anterior septal angle.

Fig. 13.

a, c. Preoperative view of a patient with post-traumatic crooked nose. Note the dorsal and caudal involvement of the septum and the "S-shaped" deviation; b, d. Postoperative view after correction through radical excision and reinsertion in an extracorporeal fashion using an open approach.