Rhinoplasty Forum and Chat

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

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.

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Information posted in this section does not necessarily reflect the opinion of Dr. Bermant.

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Question: deviated septum

I've been told that I should have surgery for a deviated septum. Has anyone had this surgery and was it successful? What problems have you had? I've spoken with other people who say they were only worse afterwards. Any comments would be appreciated. Thanks! :-)

Question: Re:deviated septum

Dr. Bermant Comments

Surgery on a deviated septum can be a worthwhile experience if done for the right reasons and by a competent surgeon. I would recommend checking with physicians other than those of your friends who were unhappy. Difficulty breathing through the nose if caused by allergies may not improve with septal surgery alone. The septum can also bend back recreating the obstruction. Most septal surgery is successful. My patients tell me they really enjoy being able to breath again through their nose again. The satisfaction rate is high, but any reputable surgeon will not guarantee results.

In your region this surgery may be best performed by various types of physicians. They may be plastic surgery or ENT specialists. You are better off with a board certified surgeon who performs this operation. They probably have patients with whom you could discuss the results. If you need help the American Society of Plastic Surgeons can be reached by calling 1-800 635-0635. They will send some preliminary information and a list of board certified surgeons in your region.

Question: deviated septum

I had surgery from a highly recommended surgeon who was very optimistic (he predicted a 90% likelihood of success), and my problem still remains (hard to breathe out of one nostril particularly in pm). Surgery was general anesth, 1 hr, spent 1 full week out of work. Nose looked like heck, but biggest hassle was the anesthesia. My only guess is to get more opinions and make sure.

Question: nasal blockage/enlarged turbinate

About three months ago, I was diagnosed by a ENT physician as having a deviated septum and enlarged lower turbinates. My symptoms were constant nasal blockage, meaning I couldn't breathe through my nose and always sounding like I had a cold. Three months later and about $16K spent, my symptoms are still there. Each day is a struggle to breathe correctly and avoid sounding nasal but when it does clear up, it is wonderful. I have never breathed so clearly before! It's an entirely new experience. Unfortunately, those moments are too few and brief. My doctor advises me that my nose is "much improved". The problem is that during the day, there is severe swelling within the nose so that breathing in is severely inhibited. Is it possible that the physician, though he won't admit it, didn't remove enough of the lower turbinates to permanently alleviate breathing problems? Any advice or suggestion on this matter will be GREATLY appreciated. -forever suffering

Question: Re:nasal blockage/enlarged turbi

I had my turbinates reduced and my deviated septum fixed. Both helped somewhat but the problem is still that my sinuses balloon out each and every time I get mold spores within 10 miles of them. And since we've had one of the wettest years ever, there's PLENTY of mold spores around.

Recognize that your sinuses are not like copper plumbing. They're living tissue. Unless you deal with what causes them to swell, you haven't completely taken care of the problem. If you don't want to do oral steroids, try NasalCrom. It's a chromolyn sodium preparation which blocks the mast cells in your sinuses from releasing histamine. Without the histamine, your sinuses won't swell. NasalCrom's based on a chemical found in some sort of Egyptian grass, if my memory serves me right.

Dr. Bermant comments:

The above post is not from me and does not represent an endorsement of this product.

Question: Re:deviated septum

I have had surgery for this but had to have my septum removed due to complications from the "root" disease which is Wegener's Granulomatosis. Don't worry, this is a very rare disease and the deviated septum was something I'd had and did need surgery for/ I can say without my septum my breathing and allergies are 100 % better but keep your septum.. I do have a very good friend who has had the same problems with her deviated septum and did go for the surgery. She is so much better and cannot speak highly enough of it.

Good Luck..

Question: Re:deviated septum

My son had this surgery three weeks ago. No improvement yet, but we are still hopeful!

Question: Deviated Septum

My 12 year old son was just diagnosed with deviated septum, he broke hisnose last year. His Pediatrician said he may need surgery as he onlyhas about 2% on the right side. The problem is that he is very sportsorientated and does participate in most running sports. Can thedeviated septum cause problems for his breathing when running? My sononly seems to notice the problem when stuffy from colds. Another symtpomis when he does sports his nose turns bright red. He also has AnkylosingSpondylitis, the probability of fusion in the rib cage is pretty good ashe suffers from sternum and rib pain, if the rib cage does fuse will the deviated septum be a problem when he needs to do his deep breathing exercises to keep some lung expansion?

Thank You,--

Dr Bermant comments:

Question: Re: Deviated Septum

Watch your son running. Most people mainly breath through their mouths when running - the normal nose is usually too restrictive for the massive amounts of air extensive exercise needs. Less heavy exercise can use nasal breathing. So although exercise breathing can be effected, it is the breathing at rest which usually bothers my patients.

Internal obstruction such as that caused by a deviated septum can impede air passage through the nose. Obstruction can be partial. Swelling of the nasal lining comes as a natural event, from irritations such as allergies and irritants, and from colds. It takes less swelling to close off the nasal passages when already partially obstructed.

Resistance to breathing can also occur with other aspects of respiration. The ribs and muscles that move the chest can be affected by rib fusion causing increased effort for air movement. Problems can be additive. Each insult causes its own piece of the total effect. I know of no studies on this last component but suspect there is so much variation in the condition and so much variation in the compensation that such studies may not be practical. Therefore I do not know the contribution that Ankylosing Spondylitis will make.

I would certainly strongly consider an evaluation by someone who knows how to evaluate the airway. In our office this is done by more than just history and external evaluation, but also endoscopic evaluation of the deeper passages. Our patient education process is extensive and time consuming.

Yes we do see patients that come from out of state. If you need the name of a local doctor, the American Society of Plastic and Surgeons can be reached by calling 1-800 635-0635. They will send some preliminary information and a list of board certified surgeons in your region.

I hope this information proves of some use.

If you are interested in more information, please call our office at (804) 748-7737.

Michael Bermant, MD

Question: Re: Post Operation

Dear Doctor Bermant, I have had two nasal operations in the past 8 years. The first was to correct a deviated septum and to reduce flared nostrils. The second operation was to make corrections from the previous operation. I am considering yet another procedure because of a snoring problem. A different ENT has suggested a septoplasty (He says I have still have quite a bit of blockage on my right side) and trimming the uvula and soft palette.

I am very concerned about the postoperative experiences I had the previous times. I had a great deal of anxiety caused by the sensation of feeling like I could not breathe due to the packing. I almost hyperventilated because of the feeling that I was going to suffocate.

My question is: Is there any way that packing of the nose can be avoided? I am terrified about the thought of having my nosed packed and my throat bleeding at the same time. Any input would be greatly appreciated. Thank you.

Dr. Bermant answers:

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

YES!!!!! I agree nasal packing is the single most unpleasant aspect of nose surgery. I try to avoid using whenever possible. However in certain cases the packing is the best way to stop bleeding or to provide the added protection to keep the dissected tissues in place during early healing. To prevent the use of packing I spend more time supporting the septal mucosa with gut mattress sutures. If this support is adequate with the underlying surgery to keep the nose in proper alignment, I then do not place packing.

Unfortunately the cartilage and bone that makes up the septum does not always behave that nicely and will not stay where it needs to be. The packing can help during the early healing stages. I use packing that has THE POTENTIAL to maintain nasal breathing. A channel through the packing lets many patients continue to breath through their noses after surgery until the packing comes out. However this channel does not stay open in all cases so that no guarantee can be made.

Surgery on the uvula and soft palate are usually for obstruction seen in snoring patients. It is rare that these structures that form the back of the roof of the mouth cause obstruction for the upright awake patient. This region is not involved in the packing.

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.

Michael Bermant, MD

Thank you for responding. I will be hopeful that packing can be avoided. I did survive the two prior procedures with the packing, so the third time's a charm, right?? Thanks again!

Question: Re: Rhinoplasty/Septoplasty

My ENT has recommended Rhinoplasty/Septoplasty for a vocal chord paralysis problem that I have been dealing with for 2 years. All other tests have been done to find out why I have vocal cord paralysis. Does this sound right? I have put off surgery trying to find second opinion. Any help you could give would be appreciated.

Dr. Bermant answers:

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

I must be missing some information here. This does not make sense to me.

If your doctor is talking about airway obstruction from the combination of resistance from vocal cord paralysis and nasal obstruction, then improving one of the partial obstructions could improve the airway. If you are talking about tonal quality and there is nasal airway obstruction, then relief of nasal obstruction might improve tone.

Nasal airway obstruction relief should have no effect on the paralyzed cord itself.

Your doctor has the advantage of having examined you. Without such an examination and a more thorough history, any opinion has no merit.

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. We try to make our patients who come to us from afar as comfortable as possible.

Michael Bermant, MD

Question: Re: Rhinoplasty/Septoplasty

The reason for the Rhinoplasty/Septoplasty is based on my ENT's theory that I am sleeping with my mouth open at night due to nasal passages being shut down at night. Why would sleeping with my mouth open at night affect only one of my vocal cord and not both? Thanks so much for responsing. I feel more informed the next time I talk to my ENT

Dr. Bermant answers:

No idea. Please let me know the ENT's explanation.

Michael Bermant, MD

Question: Re: Nose

I have been told that I have a mildly deviated septum and allergies. I have been taking clariton and have previously tried nasalcrom, both of these products helped for a short while and then stopped working. I am very frustrated and typically have trouble sleeping at night because one side of my nose plugs when I lie down, but, I rarely have much trouble breathing during the day. I had gone to an ear, nose throat doctor that told me I had a deviated septum and he put me on the drugs to help and then my company switched insurances and I had to stop seeing him. Is night time congestion, particularly on one side a symptom of a deviated septum or is it only allergies because I do not have much difficulty breathing during the day?

thank you

Dr. Bermant responds:

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

Difficulty breathing at night through the nose on one side is classic for partial nasal obstruction.

Nasal obstruction can be from a series of partial problems each alone not enough to close off the passage of air. The sum of each component can be more than additive.

Mechanical obstruction such as a deviated septum or nasal bones stays constant for the most part night vs. day. The internal nasal valve can act differently depending on the degree of inhalation effort.

Nasal lining (which humidifies the air coming through the nose) swells and shrinks throughout the day. Irritants, emotions, position of the body all affect this tissue. Lying on your back vs. on one side or the can block off one or both sides. Allergies to your bed, linen, or pillows can also cause obstruction when in bed. Relative humidity also affects lining thickness, if your bedroom's air is dry this can cause a change between day and night.

Eliminating factors that can contribute to nasal obstruction is the way we treat this condition. Sometimes medications can improve the swelling of the nasal lining adequately. Getting allergies under control can be a major help. Other times surgery will be needed to improve the mechanical passages.

You sound like you need further evaluation. 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.

Michael Bermant, MD

Question: Re: deviated septum

Hi my name is ... and i was wondering if you could give me your opinion on this story------
My fiancee first noticed something was wrong as we traveled from new york city up to new paltz (mount area). By the time we went to start on the hike he felt very badly and could not get far so we turned back he did not feel well driving also

he went to the doctor and he concluded that he had an ear infection- so he took antibiotics for a week or so and did not feel better

he went back to the doctor and he said to get a hearing test (set for a month later)

since he was feeling progressively worse, he went to the doctor earlier than the month's time and he felt he should do the deviated septum-

at this point several times driving to higher places he would feel very badly-- his other big problem is that his ears are blocked up, and he cannot breathe (which has been a bigger problem than he realized)

well, he went for the deviated septum operation on Friday and was supposed to get the packing out on Saturday (he had splints in also) on Saturday when he called the doctor he told him that he could leave the packing in until Monday since he was not bleeding a lot and seemed to be doing okay

on Monday he went to get the packing out and the doctor had a hard time removing the packing-- so he gave my fiancee some nasal spray to soften up the insides of his nose and he went back again and finally it got removed- he also had an excruciating pain when the doctor removed the splints- apparently they were attached by some sort of stitching (is this common?)

does it sound like this doctor knows what he is doing????

after that he could still not breathe well and he went back to the doctor and right in the office the doctor removed "scar tissue, etc., which took a long time) and then replaced packing

the operation was on March 14th and he still cannot breath, and his ears and still uncleared-
thanks for listening-

\if you could please tell me if there's some sort of specialist or someone else he should see- this doctor is not really giving him any information and says he's not sure whether his ear problem will be solved anyway-

thanks again- i can be reached as

Dr. Bermant responds:

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

Nasal packing is no fun but necessary at times. Yes taking it out can be difficult. Silicone splints are often sewn together about the septum and getting the suture out without discomfort can be an art form.

If raw surfaces heal together inside the nose an adhesion forms which sometimes needs to be divided and sometimes new packing placed during initial healing.

Septal deviation can push the turbinates and obstruct the sinus opening just behind the turbinates. Swelling needs to go down before much improvement takes place. If surgery was performed on March 14th, there has not been enough time.

I do not generally treat ear obstruction . infection but this can be related to a deviated septum that is pressing against the eustachian tubes (the equalization valves in the back of your nasal passageway).

I feel doctor patient communication is essential. Go back and tell your feelings to your doctor. Sit down and talk and ask your questions. My patients get their education as part of the surgical experience, but different doctors practice as they see fit.

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: Re:Deviated Septum

Dr. Mike,
Got my polyps/deviated septum surgery today. No extended lightheadedness. Thanks for the post. Talking to other people about this subject made it easier for me to go through with this surgery.

Dr. Bermant answers:

Glad all went well,
Michael Bermant, MD

Question: Re: Septoplasty

I just found out that I need a septoplasty. My ENT said that my air flow is 100% blocked on my left side, and 80% blocked on my right side. He also said that I have some kind of alveo-maxillar cyst (?) that needs to be removed, and also something about turbinates being swollen. I'm so frightened!!!! Are they going to break my nose? Will it heal to look the same way again? I'm only 21, and have never had this kind of surgery before. As I was perusing your bulletin boards, I couldn't help but notice that the success rate isn't very high. I will be living in Europe for a year, and i can't exactly fly back to Florida in case something goes horribly wrong. I also have a bad allergy to dust mites. Does my case seem hopeless?? Thanks for listening to me rant!

Dr. Bermant responds:

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

You need to calm down. This series of questions needs to be directed to the doctor who will be operating on you. If you do not feel comfortable with your doctor's answers, find someone who you are comfortable with. I have not examined you nor evaluated you and so find it hard to comment on your questions. Sit down with your doctor and talk.

The failure rate for septoplasty in general is not that high, but it depends on the extent of the problem. Flying to see a doctor is no longer very strange in this day and age, but there are also doctors in Europe if "something goes horribly wrong" during the year abroad. Structural surgery does not change the effect of environmental allergens. Obstruction caused by both mechanical and allergies can be improved by improving either problem. No, your case does not sound helpless. You just sound concerned and need further education before deciding to embark on the road to surgery.

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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