Septoplasty versus Rhinoplasty: What is the Difference?

A general Otolaryngologist (ENT) is usually the first person a patient sees when they have difficulty breathing through their nose in Cincinnati, Ohio. There are multiple causes of nasal obstruction. A deviated nasal septum is one possible cause. Repair of a deviated septum can often improve nasal obstruction. However, the cause of nasal obstruction may involve not only the septum but also the cartilage and bones that give the external shape to the nose. It is in those cases that the patient is usually referred to a sub-specialized, fellowship-trained facial plastic and reconstructive surgeon. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck.

Septoplasty and Rhinoplasty are Not the Same Procedure, Which Matters to Patients

Are septoplasty and rhinoplasty the same procedure?

No, septoplasty and rhinoplasty are different procedures. However, they are often performed together. Both procedures are performed for the purposes of improving the appearance and/or function of the nose.

What distinguishes the procedures and why does this matter to patients?

The differences between a septoplasty and rhinoplasty matter to patients because these differences help frame expectations about the anticipated recovery and results from these procedures.

A septoplasty is a surgical procedure whereby a portion of the wall — composed of cartilage and bone — sandwiched between the soft tissue composed of mucosa is removed. The purpose of a septoplasty is twofold:

• Remove a portion of the septum that deviates into one or both nasal cavities and causes obstruction that limits a patient's ability to breathe through their nose.
• Harvest cartilage and, sometimes, bone to use as a graft when performing rhinoplasty surgery.

In contrast, a rhinoplasty is a surgical procedure whereby the shape of the external nose — including, but not limited to, the complexly shaped and oriented cartilage and bone — is altered. The purpose of rhinoplasty surgery is twofold:

• Improve the appearance of the external nose.
• Improve the function of the internal nose.

In other words, the purpose of rhinoplasty is to make the nose look better and to make patients breathe better through their nose.

The Septum is a "Wall" Composed of Cartilage and Bone

The septum is a "wall" composed of cartilage and bone that separates the left and right nasal cavities. The septum starts at the front of the nose and ends at the back of the nose into a common opening called the nasopharynx, which sits above and is continuous with the throat.

The front of the septum is primarily cartilage. This quadrangular cartilage supports the nasal bridge and tip. The back of the septum is composed of multiple bones that have fused together and which extend from the skull base to what is referred to as the "floor" of the nose.

The Severity and Location of Deviation Contributes to the Severity of Nasal Obstruction

A septum that causes nasal obstruction is usually deviated or curved from the midline. The deviated portion of the septum can be composed of cartilage, bone, or both. A septal deviation can occur due to trauma, or it can be the result of genetics.

A septum can be deviated to one or both sides (i.e., S-shaped septum). The more severe the deviation to one side, the more likely it is to cause nasal obstruction.

A septum can be deviated low, towards the nasal floor, or high, towards the nasal bridge. The lower the deviation is in the nose, the more likely it is to cause nasal obstruction.

A Septoplasty Procedure Can Improve Nasal Obstruction Secondary to a Deviated Septum

A septoplasty utilizes an incision inside the nostril to remove the deviated portion of the septum (cartilage and/or bone). Some cartilage is left behind at the nasal bridge and tip. This cartilage functions as a strut to minimize the risk of deformation of the nasal bridge and/or tip.

A Rhinoplasty Can Address More Complex Causes of Nasal Obstruction

In contrast, a rhinoplasty involves the manipulation of the complex of cartilage and bone that contributes to the external appearance of the nose. A rhinoplasty can be performed with all of the incisions inside the nostril in some, select cases. However, a rhinoplasty is performed utilizing a small incision at the base of the nose in most cases. The procedure can be performed to improve nasal breathing if these external components are narrowed and contribute to the nasal obstruction. A rhinoplasty can also be performed to improve the appearance of the nose.

A Rhinoplasty and Septoplasty Can be Performed Together

A septoplasty is often performed with a rhinoplasty not only to improve breathing but also to supply cartilage for grafting for rhinoplasty. Cartilage removed from the septum can be used as a supportive and shaping graft to improve nasal obstruction and/or the appearance of the nose.

Double Board-Certified Facial Plastic Surgeon Dr. Jeffrey Harmon is a Specialist in Nose Surgery (Rhinoplasty and Septoplasty)

It is very common for both septoplasty and rhinoplasty to be performed together, both to improve nasal aesthetics and function. Whether one or both procedures are performed and for what purpose(s) is determined by each patient's concerns and an evaluation by Dr. Harmon. The procedures are performed together when the cartilage and/or bone removed from the septum is used as a graft, placed in the external nose to open narrow areas that restrict airflow or to adjust the size and/or position of the:

• Nasal tip
• Nasal bridge

To improve the appearance of the nose.

Some patients seek the expertise of Dr. Harmon with concerns about nasal breathing. Others have concerns about the appearance of their nose. And still others are referred from general Otolaryngologists/Ear Nose Throat (ENT) surgeons for one or both of these concerns when they feel a surgeon who has advanced fellowship training specifically in facial plastic and reconstructive surgery is best-suited to treat them. Dr. Harmon sits down in consultation with each patient and listens to their specific concerns and desires. He then performs a detailed physical examination to determine what may be contributing to their concerns. Finally, he develops a personalized plan in collaboration with the patient to address their concerns.

Frequently Asked Questions

Can septoplasty surgery change the appearance of the nose?

No, the purpose of a septoplasty is not to change the appearance of the nose. The area of surgery is located inside the nasal cavity, not externally. However, one risk of septoplasty surgery is that the appearance of the nose changes due to weakening of the structural support to the external nose provided by the septum. It is for this reason that either some of the structure of the septum is preserved, enhanced, and/or replaced during surgery to minimize this risk.

Does insurance cover septoplasty?

Yes, insurance generally covers septoplasty when the purpose of the procedure is to treat a deviated nasal septum to improve breathing.

Will I need both a septoplasty and a rhinoplasty?

No, you will not necessarily need both procedures. Dr. Harmon determines whether one or both procedures are most likely to address a patient's concerns through a detailed physical examination.

How do I know which procedure I need?

A consultation with a physical examination is required to determine the surgical approach. Whether surgery is advisable and which approach is advisable depends on multiple factors including, but not limited to, each patient's medical history, surgical history, and anatomy.

What Nasal Breathing Symptoms and Aesthetic Concerns Mean for Patients

Dr. Harmon evaluates each patient individually to determine what the anatomy actually requires, not necessarily what a patient assumes they need. This is especially the case for patients who present with difficulty breathing through the nose with or without desired aesthetic changes.

It is common, for example, for a patient to arrive in consultation with a request for septoplasty surgery or a referral for septoplasty surgery from a general ENT. The patient may or may not have had imaging (e.g. CT scan) that supports their belief that a septal deviation is causing symptoms they are presenting with.

The most important things to understand are what, exactly, their symptoms are and in what context. Are they having trouble breathing from one or both sides of the nose? Has this obstruction been present for many years, months, or only weeks? Is the obstruction constant or does it vary? If it varies, is there a potential cause, for example, changing seasons? Are they using medications administered nasally such as a steroid or oxymetazoline (e.g. Afrin®) that could potentially affect their nasal cavities? All of this information — and more — matters. This is because the nasal cavities are not simply a house with inert walls (i.e. sinus walls, septum) and a roof (nose). The soft tissue mucosa enveloping the nasal cavities consists of multiple layers including a surface that can swell or shrink with infection or allergens and submucosal blood vessels that swell and shrink cyclically throughout the day. There are some conditions that can lead to the perception of nasal obstruction despite largely patent nasal airways, possibly due to alterations in the sensory receptors in the nose that detect airflow and moisture.

It is for the above reasons that a detailed history and physical exam is essential, not only because imaging findings do not necessarily reflect the level of actual obstruction but also because there may be other, more important factors at play when evaluating a patient. A patient may, for example, be seeking a septoplasty for headaches and/or chronic or recurrent sinus infections, neither of which should be expected to be treated by a septoplasty in most circumstances. Another patient may have been using intra-nasal oxymetazoline for months or years which has caused chronic swelling of the soft tissue in the nasal cavities and resultant nasal obstruction.

Sometimes, for reasons unclear, the level of visible obstruction from the septum on a physical exam may not match a patient's reported symptoms. A patient may describe severe obstruction on one side but have septal deviation to the opposite side. Another patient may have severe septal deviation but report no nasal obstruction. Yet another patient may have nasal obstruction secondary to narrowing of cartilage and/or bone on the nasal bridge or unstable, collapsing nasal cartilage at the tip. Such patients may benefit from rhinoplasty surgery with a septoplasty only to harvest cartilage and place grafts that open these narrowed areas of the nose.

Finally, for those patients seeking both functional improvement in nasal breathing and aesthetic improvements in the nose, there are times in which the aesthetic goals of rhinoplasty surgery partially or completely conflict with the maneuvers necessary to improve nasal breathing. For example, many people seek a smaller nasal bridge and a narrowed, more refined nasal tip for aesthetic rhinoplasty surgery. In contrast, treating nasal obstruction at the nasal bridge and/or tip often involves placing a graft to stent the nose open. While such maneuvers tend to have a minimal effect on the external appearance of the nose, they certainly do not narrow it. That does not mean, however, that nasal aesthetics cannot be improved at the same time as nasal breathing.

The decision on how to proceed balancing functional and aesthetic surgery on the septum and nose is difficult. Dr. Harmon feels it demands the expertise of a fellowship-trained, double board-certified facial plastic surgeon who is a specialist in caring for the nose.

Trust Your Face to a Facial Plastic Surgeon

It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck.

Why Choose Dr. Harmon

• The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good.
• Dr. Harmon is a double board-certified facial plastic surgeon.
• Dr. Harmon values making patients feel welcomed, listened to, and respected.
• Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology.
• Dr. Harmon earned his medical degree from the University of Cincinnati.
• Dr. Harmon underwent five years of extensive training in head and neck surgery at the prestigious residency program at the University of Cincinnati.
• Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City.

Request a Consultation

Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more!

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