Rhinoplasty Forum and Chat

Support Forum, Chat, and Message Board for Patient's Questions and Answers Nasal Obstruction, Deviated Septum, Septoplasty, SMR, & Submucous Resection 2

Explore what others have to say about Nasal Obstruction, Deviated Septum, Septoplasty, Septorhinoplasty, and Plastic Surgery with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

  • Why did you choose to have the surgery?
  • How did you choose your doctor?
  • How much did it cost?
  • Was the final cost the same as what you were told before the surgery?
  • How was the recovery?
  • Were there any complications? How were they resolved?
  • How do you feel about the results?
  • Did it have any effect on your life
    • emotionally
    • socially
    • sexually
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  • How did others react to your surgery?
  • Did you learn any lessons?
  • What would you advise others?
Information posted in this section does not necessarily reflect the opinion of Dr. Bermant.

E-mail to Dr. Bermant

Rhinoplasty Nasal Surgery Important Information

Question: Re: Nose

Dear Dr. Bermant,
I am a 24 year old male. I broke my nose when I was 15, but never went to the doctor. For the past 3 years I have been getting sinus infections. I also can "pop" my ears whenever I want to. I sometimes need to because my ears feel blocked up. I recently went to the doctor, and he said I should have the cartilage inside of the middle of my nose straightened out. Is this something you would suggest? As a result of the break, my nose is slightly "tipped" to one side. Because of this, my profile from one side has a bump. The bump does not appear to be bone growth. It seems to be because the bridge of my nose is "tipped." I asked the doctor if he could re-center the bridge of my nose when he did the nasal surgery, and he said he would not suggest it. He said it could cause a change in shape of the bone when it heals. He said he would rather file the bump down. I'm not sure what method is best. Is it possible to reset the bridge to how it was? Like I said, I think the shape of the bone is the same as always, but it is not centered. My preference would be to have my nose go back to how it originally was. Is this possible? I would like to have something done because I am very self conscious of the appearance of "my bad side." I even attempt to talk to people while looking at them from "my good side." I would appreciate any advice you could give me.
Sincerely, ...

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Nasal deformity after fracture is very common. The deformity can be both inside and outside the nose. Both internal and external deformities can affect the flow of air inside the nose.

The turbinates are structures inside the nose that add humidity to the air as it passes through the nose. The turbinates can grow (hypertrophy) in reaction to the air pattern inside the nose. Environmental irritation, allergies, turbinate hypertrophy and distortions from deformity can lead to obstruction of the holes behind the turbinates. These holes are the openings to the sinuses. Obstruction to the holes can lead to sinus pressure and problems.

Behind the turbinates is the opening to the ear's eustachian tube (the pressure equalization system of the ear). This can be blocked by similar mechanisms.

Advice about correction of problems needs an evaluation. I cannot comment without an examination. There are many possible problems and many options depending on those specific problems. The doctor who you trust to do the correction should be the one who explores these options with you. Our commitment to education and the time we take with our patients helps build that confidence in our patients. Since some patients travel to have me help them, our office staff will be glad to assist in this process.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: A 2nd operation

Around 20 years ago I had surgery to fix a deviated spetim. Long story short - the septim was not corrected and the bottom part has been resting on my right nostril. I'm sure I have to have surgery again, however, I have no faith that the septim can be fixed. Anyone out there with similiar problem?

Dr. Bermant responds

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

The septum has memory. Correcting septal deviation can be difficult. Many patients have similar concerns, it depends on what their expectations were. My patients have an explanation that helps them understand the nature of the surgery such that a more realistic expectation is possible. We have several methods for correcting this problem and sometimes have to repeat surgery to correct this problem. Check out my web page for similar patient questions and responses.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Thank you for the info. I visited your web site and found it very informative also. On your web page you stated that infection was rare after surgery. I'm one of the rare ones. My doctor said I'm the only one of his patients to have this many problems with this surgery, the only one to get an infection. I honestly think he feels worse than I do. I had hematomas that the doctor was concerned about and I ended up being "cut on" again on the 29th and then again, more extensively on the 1st of this month. I have packing in my nose, and it is awful! My nose is so swollen and painful. I will return tomorrow to see what happens next.

Thanks again for your information,

R E

Dr. Bermant responds:

Good luck. Sometimes we cannot avoid the nasal packing.

Michael Bermant, MD


Question: Re: deviated septum

First let me express my thanks to you for your comprehensive information.

I am a 62 year old male,very athletically active, ski, tennis, rollerblade etc. My ENT has recommended on more than one occasion that I need to have my septum corrected, however every time I begin to seriouslly consider surgery I just cant bring myself to go ahead. I know what has made me so apprehensive, One , the packing issue and two the no promise that the results cant be guarnteed . I have had three opinions and they are all the same, but here I am still having a problem. My symptoms generally fall into many of the other suffers symptoms, nigh worse than day some days no problem at all other days poor. Whow, what a quandry. As I write this I think maybe I need a psyciatrist moor than a ENT. Thanks for being there .

H.

Dr. Bermant responds:

Thank you. By the way, I am a Plastic Surgeon not an ENT. Were you reading my comments on bulletin boards on aol or my web page?

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

No good surgeon will guarantee results, that is just the way surgery is - an art - not an EXACT science.

My patients benefit from my own dislike of packing. Although some cases packing is necessary, most cases can be done with several techniques that permit me to improve patient comfort after surgery. I generally suture the mucosal layers back together with a mattress stitch - time consuming but better. Sometimes I use a temporary silicone stent that supplies additional protection. The channel in the splint frequently stays open permitting air to pass through the nose. For cases where oozing is difficult to stop or the nose needs the internal support during the initial after surgery period, packing is sometimes necessary. very few of my patients have needed packing. Unfortunately my methods are for my patients, you cannot tell another doctor to do it another way.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: septorhinoplasty/ rib graft

To Dr.Bermant.

I have had 4 cosmetic surgeries done over the last ten years by two differnt plastic surgeons. One of the surgeons did my nose twice and then I went to a better, higher recommended surgeon for the latter two operations. For the last five years, it has become harder and harder for me to breathe out of my nose. I finally went to a plastic surgeon that was recommended to me. (As my previous good surgeon no longer takes patients covered by medical services plan). He checked my nose and he told me that one whole side of my nose was collapsed and the other side didn't look too good either. He will perform septrhinoplasty on me this August.

My surgeon has told me because of my previous cosmetic surgeries (one dr. was good, the other not so good) that I may have no (or hardly any) cartilage left in my nose for him to work with. He told me he may have to go into my ribs and do a rib graft to get rib cartilage. I had had ear cartilage used in the past but this surgeon told me rib cartilege is better and he wants to use that instead.

My question is: Is this a safe procedure? Is it common? My surgeon assures me it is safe and I do trust him but I wouldn't mind a second opinion.

Thank you so much for your time!!

S.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Rib is a normal donor site for cartilage, especially for larger or more sturdy pieces. Ribs move with breathing. After rib cartilage surgery, a patient may experience some discomfort with breathing until the chest heals. This pain may not even be great enough for pain medication. Behind the rib is the chest cavity. Occasionally with rib harvest, a hole into the chest cavity may cause the collapse of a lung. This may require a chest tube to help expand the lung for a short period of time. Some nerves near the ribs can be injured causing some altered, diminished or painful sensation which usually resolves. Where rib cartilage is one of our worse parts of our body for scarring. Sometimes this scar can be significant. Usually none of these problems becomes a big issue and rib cartilage is a fairly safe donor site.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Cartilage

Dear Sir,

I hope you can help me. I am in my 40's and have had two nose jobs, age 16 and 20 respectively. Of late, I have much difficulty breathing. I have seen two consultations in N.Y.C. I believe the major problem for me is the cartilage at the tip. However, from my discussions, I get the feeling that too much cartilage was removed from the previous surgery. Therefore, the surgery may be a difficult one, or,, may not make that much difference in my breathing. Is that true? Do you know anywhere I can turn to , to get more information?. I seem to be getting differing opinions from the doctors I've seen thus far, all reputable! My E-mail address in .... I would be most appreciative for any information you can pass on. Thank you so much!

Dr. Bermant answers:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

That question is a difficult one to answer without an examination and evaluation. If too much cartilage has been removed from a tip and there is a breathing problem, then correction can be difficult. It depends on the deformity, your skin, the scars, and other factors. Sometimes cartilage can be grafted from another site moving the nasal valve laterally (if that is what is causing the obstruction). Other times the upper lateral cartilages can be moved laterally with a spreader grafts. The same problem many times has several solutions each of which may handle the job.

The topic is just too broad to cover without the added benefit of a consultation. Additional information is difficult to come by unless you want to start reading any of the many textbooks on rhinoplasty. The detail you are asking is way beyond even what is on my extensive website and is best handled in the doctor's office.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Question: Re: Cartilage

Dear Dr. Bermant,

I so appreciate your reply as to my question pertaining to a possible rhinoplasty. Naturally, I will pursue a further evaluation. I thank you so much for taking the time to give me added information. Sincerely. R


Question: Re: A 2nd operation

I just had a septoplasty done last week and I was a complete basket case. I had a real problem with vomiting after surgery and had to go back to the hospital. Then I had the sutures from one of the splints break loose and the splint fell back into my sinus cavity (I guess that's where it was). When it fell back, I couldn't eat or drink anything, so I went back to the hospital. The ENT doc removed the splint and I felt so much relief that I would have kissed the doc if my wonderful husband wasn't with me. (Just kidding). I just have a question or two. I still can't taste or smell. When do these senses return? Or do I have a problem? I also feel like there is an awful lot of thick mucous in my sinuses. Will this go away? Anyone with answers please let me know. Thanks. E

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

These are all valid questions that you should ask your doctor. Post surgical swelling can affect how the air travels through the nose. If air is blocked or does not travel to the upper areas of the nose where the smell sensors are, then smell can be impaired. Since smell is involved in the "taste" of foods, "taste" could be also be altered. The nerves to the tongue should not be involved so that this aspect of taste is usually not a problem. The taste part of the palate (roof of the mouth) has some taste sensors that can be dulled by surgical swelling. As tissues return to normal, most of these problems correct themselves.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: septalplasty

Dear Dr. Bermant MD. My most sincere thanks to your for your immediate response to my questions re: deviated septum. I do have another question . Would you explain what the recovery process is like? How long , time off work, discomfort, how long before one can resume active sports? Thanks again in advance for your quick response. To answer your question re your comments. I found your web page on EXCITE by entering ( septum ). Thanks once more. H.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Recovery is a function of what was done for the septal surgery. You will need to ask this question of the doctor who you are planning surgery with. Septoplasty is the name for a group of operations (maneuvers) to correct the deformity. Septoplasty is frequently coupled with other operations like turbinectomy or rhinoplasty. Each has its own recovery characteristics.

Simple septalplasty with cartilage scoring usually needs 4-6 weeks without vigorous activity. Other procedures may need longer periods of protection. Most patients are back to work within a few days. Discomfort tends to be mild to moderate and is more related to swelling and pressure than basic pain (unless the nose is hit - then it will hurt). Within 2 days the major part of the swelling resolves, but further swelling decreases over the next 1-2 weeks. Subtle swelling may persist for several months as the tissues soften during healing.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: septalplasty

In a message you wrote:
Dear Dr. Bermant. My thanks to you once again for your concise and very informative info regarding my expected recovery time etc. Your commentshave been very helpful in helping me to reach my decision to proceed withmy septal surgery. H.

Dr. Bermant responded:

good luck

Michael Bermant, MD


Question: Re: Post-septal surgery

Dr. Bermant,

I am having headaches at night and upon awakening coupled with lightheadedness. I am keeping a "headache diary" and almost every time I have these headaches, I also have total blockage of one side of my nose. Had septoplasty one year ago and the side that I was having difficulty with and the one I didn't, have reversed. I have tried avoiding danger foods, caffeine, nutrasweet, etc. I am seeing my ENT today and am having a CT scan (?) tomorrow to check for brain tumors. Allergies used to be a problem, but shots have all but eliminated this problem (though I haven't had shots for several months). Symptoms have worsened recently, but have been going on for months. Headache and lightheadedness almost disappear during the day. Any advice?

S

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Sounds like you are doing the right thing. An examination and evaluation by a good doctor is probably the best thing to help understand what is the problem. Looking for obstruction of the sinus passageways to the nose can give some information as well as the x-rays you mentioned. Hard to comment further without being able to examine and evaluate. Septal deviation is difficult to correct and recurrence is not uncommon. Sinus obstruction can occur from the changing dynamic anatomy of the internal nasal structures.

Good luck

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

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Rhinoplasty Nasal Surgery

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