Is a plastic surgeon a good choice for fixing a deviated septum?

There are some great answers here.  I agree that both ENT (facial plastic surgeons) and plastic surgeons are well trained to handle this issue.

However, what you should focus on is finding a surgeon that also has experience in redo rhinoplasties.  Trying to fix a problem a second time around can lead to additional challenges.  A board certified ENT or plastic surgeon is a good place to start, but make sure you find someone who has experience with redo (revision) rhinoplasties.

I hope this helps!

Whether you see a plastic surgeon or an ENT, your surgeon should listen carefuly to your problems, do a careful examination, and be able to point out to you what your fixable issues are, if any.  Sometimes patients with breathing problems need to see an allergist, not a plastic surgeon.  You should feel very comfortable with the consultation and the doctor's expertise, thoroughness and concern for you.

If you are simultaneously considering aesthetic improvement of the nose, you should feel that the surgeon is well versed in aesthetic rhinoplasty.  The plan for your nose should feel very specific to the issues.  the plan should make basic sense.  You may want to look at a number of before - after pictures, to see the doctor's style.

There are many fine surgeons from both the ENT and the plastic surgery camps. 

Oh, turf battles are fun. ;-)

My colleague here mentioned Jacques Joseph as one of the pioneers of rhinoplasty in the early 1900s, which is quite true. But Dr. Joesph was not a general plastic surgeon.

In fact, Jacques Joseph was originally trained as an orthopedic surgeon. However, given his expertise in nasal surgery (and otoplasty...ear pinning) he was later appointed head of the facial plastic surgery section at the Royal Ear and Nose Clinic of the Charite´ Hospital in Berlin by the Prussian Ministry of Education and Cultural Affairs.

--DCP

Hi Banker Mama,

You first need to be diagnosed.  The cause of your nasal obstruction needs to be determined by a surgeon who specializes in the function of the nose.  Certainly ENT surgeons are well trained in the diagnosis and treatment of functional nasal breathing problems.  There are facial plastic surgeons and plastic surgeons that are just as qualified to correct the problem.

You should seek out a physician who uses either Somnoplasty or Coblation in their office, radiofrequency techniques that reduce the volume of excess obstructing inferior nasal turbinate tissue.  You may be able to avoid surgery, the operating room and anesthesia completely while being able to breathe better that you ever have in your life.

Good luck and be well.

Dr. P

If you like the shape of your nose, you don't need a plastic surgeon ( or even a facial plastic surgeon). You need someone who specializes in fuctional problems of the nose and sinuses.  And you need a good evaluation.  Breathing problems are often not caused by a deviated septum.

Make sure you have a board certified ENT doctor.

You can use the services of either a General Plastic Surgeon who specializes in cosmetic and functional nasal surgery, or an ENT/Facial Plastic Surgeon who specializes in the aforementioned. Board-certification is a must.

Preoperative evaluation of your breathing issues with a CT scan may bring forth other issues that are better treated by an ENT/Facial Plastic Surgeon such as polyps or sinus problems. Otherwise for a straight-forward deviated septum the only matter of importance is the skill and experience of your surgeon.

Good luck. Dr. Shah

Both plastic surgeons and otolaryngologists are trained in the correction of functional problems of the nose, so either would be a good choice.  If you have frequent sinus problems, e.g. sinusitis, you may need to have a procedure that allows the sinuses to drain better (functional endoscopic sinus surgery, FESS), best performed by an ENT.  Your primary care physician may be able to start the ball rolling with a CT scan if this is the case and refer you on to either a plastic surgeon or ENT surgeon, if FESS is required.  Good luck!

Plastic Surgeons and Facial Plastic Surgeons are both well-trained in surgery of the head and neck area, including Cosmetic and Functional Rhinoplasty and Septoplasty.

When it comes to functional problems with the nose causing breathing difficulties, it is important to have a thorough evaluation of the nose in order to arrive at the proper diagnosis and treatment plan.  Many factors can cause nasal obstruction, including previous surgery on the nose, and the septal deviation may not be the only problem, or the primary problem.  Unless there are problems related to sinus blockage, both "general" plastic surgeons and "facial" plastic surgeons are equally qualified to diagnose and treat the blockage.  If the sinuses are not draining properly, an ENT surgeon might be the better choice to perform an endoscopic procedure to dilate the sinus orifices, allowing better drainage.

Both Plastic Surgeons and Facial Plastic Surgeons (usually ENT physicians) can help with your problem. The key is that they have a special interest in nasal surgery, both functional and cosmetic. You need a doctor who spends a significant amount of his or her practice focused on the nose. So ask how many nasal surgeries they do each year and compare the answers you hear. Also, ask to speak with a patient or 2 who have had a procedure like the one proposed for you and see if they are happy.

Plastic Surgeons (Certified by the American Board of Plastic Surgery) are well trained in both the cosmetic and functional aspect of the nose.  I would suggest, however, to go to a plastic surgeon who does a lot of nasal surgery. Some plastic surgeons do not do a lot of nasal surgery and a phone call to the office can clarify that for you.

The short answer is "yes". I think either a Board Certified Plastic Surgeon or an Ear, Nose and Throat Surgeon who is also properly trained will do just fine. Don't let your previous experience when you were 17 discourage you-- if you're having difficulty with your airway, there is usually a good and safe solution. Have someone with the proper training and experience examine you and give you some options for correction.

Turf wars abound in cosmetic and plastic surgery venues.

American Board of Plastic Surgery has been around since 1931. Plastic Surgeons have won the Nobel Prize in Medicine for kidney transplant. Plastic surgeons are on the forefront of stem cell work and tissue engineering. Plastic Surgeons were the doctors to perform facelifts and rhinoplasties since the turn of the 20th century (Jacques Joseph 1904). Plastic Surgeons have rigorous training that involves thorough training in rhinoplasty, as well as functional airway management, including internal nasal valving, turbinate hypertrophy and septal deformities.

Many younger plastic surgeons are trained by senior faculty with decades of experience in cosmetic surgery, reconstructive surgery, trauma, oncology and pediatric plastic surgery. In my training program, many people from other specialties including ENT came into our surgical suites to observe our faculty performing the latest procedures.

Many ENT doctors pursue plastic surgery residencies after their training. There are many excellent physicians that perform these procedures in other specialties, but in the end I am proud of our societies and the framework that they have created to make us the best trained physicians possible.

Surprisingly enough, a deviated septum is not usually the cause of nasal airway obstruction. Very few people have absolutely straight nasal septum. The lower lateralturbinates, a swelling of bone covered with mucosa, normally regulates the flow of air through the nose. If the septum is curved or tilted, the turbinates adjust be shrinking or swelling. Ordinarily, one side of the nose is usuallymore obstructed than the other. If one side is always blocked more than the other, then a structural  problem may exist. The flow of air isa dynamic event and the regulation is controlled by numerous structures and factors. It is usually these elements (i.e. interal valve, external valve, turbinates) rather than the static deviated septum that are at fault. A well-trained plastic surgeon should be in tune with the dynamic function of the nose and should be able to adequately diagnose and treat this problem but be sure who ever treats it is knowledgeable about airway dynamics , not just cosmetics.