What is Septoplasty?

The nasal septum is the cartilaginous structure that resides inside the nose in the midline and that divides the two sides of the nasal cavity from one another. It can be deviated either due to a congenital reason (you were born that way) or due to past trauma. Deviation can cause nasal airway obstruction, which may be evident at rest or only during varying degrees of exercise. There may be obstruction only on one side only or both sides to varying degrees, that is, it could be worse on the left or right side or bad to the same degree on both sides.

A septoplasty involves reshaping the bent nasal cartilage to help with functional improvement as part of breathing. A septoplasty, despite sounding like a simple procedure, can be quite complex and challenging depending on the location and extent of the deviation. Dr. Sam Lam, a trusted rhinoplasty surgeon, is also board-certified in otolaryngology-head and neck surgery, more commonly known as ENT (or Ear Nose and Throat). His goal with every surgery is not only to give you a more beautiful nose but also help enhance and maintain your nasal airway.

Should I have a Turbinate Reduction?

There are three turbinates in each side of the nose: inferior, middle, and superior. Only the inferior turbinate can interfere with nasal breathing. Rarely does Dr. Lam feel the need to reduce the inferior turbinate but sometimes he feels he should do so. The turbinate is a structure with purpose: it humidifies the nose, warms it, cleans the nasal passage, and also conducts air through the nose in a laminar fashion (meaning it reduces turbulence and allows for a smoother flow of air). For these reasons, Dr. Lam believes that reducing the turbinate through removal may impair these functions and lead to other problems. In certain cases, which he will discuss with you if you are a good candidate, he may move the inferior turbinate over but not actually remove it to help improve the nasal airway. As mentioned, he does not always do that but would need to determine your candidacy for this procedure based on a physical examination of the inside of your nose.

Does Dr. Lam Perform Sinus Surgery Too?

Although Dr. Lam is not only board certified in facial plastic surgery but also in otolaryngology (ENT), he has never practiced ENT after his training, choosing to specialize only in cosmetic procedures and functional rhinoplasty (see below for description). He can refer you to a qualified ENT surgeon in the area if you desire sinus surgery correction.

Is Septoplasty a Part of Rhinoplasty?

In short, yes. Dr. Lam almost always performs septoplasty as part of his rhinoplasty procedure even if you do not have a deviation to your septum. There are two basic reasons. The first is that he harvests septal cartilage as a graft to be used during the rhinoplasty. The second is that he attaches that graft to the bottom of the septum to support the nasal tip from collapse. This is known as an extended caudal septal extension graft (yes, a mouthful). Dr. Lam believes that this graft is a critical aspect to his rhinoplasty surgery, so he will be working on your septum whether you need one or not. Accordingly, if you have a deviation, he will work to correct it during the course of your rhinoplasty. It is naturally part of your rhinoplasty surgery.

What is Functional Rhinoplasty?

Functional rhinoplasty surgery involves changing the shape of the nose to help you breathe better. Sometimes a septoplasty alone will be insufficient to help you breathe well enough. For example, there is an anatomic structure known as the internal nasal valve that involves the triangle of the septum, the upper lateral cartilage (the middle section of the bridge of the nose), and the inferior turbinate. The internal valve is the most common area of obstruction and a septoplasty alone may not fix valvular collapse. A spreader graft may be needed to open this valve along with a septoplasty and possible turbinate reduction (see above for details). Dr. Lam performs what is known as a modified Cottle maneuver in the office along with a careful intranasal inspection to see if you would benefit from this procedure. There can be other structural problems that can impair breathing that may also compromise your cosmetic appearance. For example, if the nasal bones are broken, you will have a deviated nasal bridge appearance, that is, a crooked nose, and also that collapse can cause nasal obstruction, which would be benefited by straightening the nasal bones in addition to septoplasty.

Who Should Perform My Septoplasty?

If you simply have a deviated nasal septum without a cosmetic problem and/or a valvular collapse, then an ENT surgeon may be able to do it for you under insurance. However, most ENT surgeons are not comfortable or experienced performing advanced airway corrections and/or cosmetic changes to the nose. Another problem is that many ENT surgeons fail to diagnose valvular problems because they do not think of those issues since they do not usually know how to manage this condition. Finally, it is important to avoid undergoing septoplasty if you are planning a rhinoplasty because a scarred septum is much harder to work on and you can take valuable grafting material away that Dr. Lam could otherwise use during your rhinoplasty procedure. Of note, Dr. Lam does not charge extra for the septoplasty portion but considers it part of the rhinoplasty.

Does Dr. Lam Take Insurance if I have a Deviated Septum and Need a Septoplasty?

In short, no. Dr. Lam does not accept insurance nor will he file your claim for insurance. All of his procedures are entirely cash basis.