Rhinoplasty Forum and Chat

Support Forum, Chat, and Message Board for Patient's Questions and Answers Nasal Obstruction, Deviated Septum, Septoplasty, SMR, & Submucous Resection 5

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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Rhinoplasty Nasal Surgery Important Information

Question: Re: Deviated septum

Hi,

The only thing that bothers me about my deviated septum is that it's hard to breathe during sleep/sports, would surgery significantly help this (and for how long - permanently?)or would it just possibly help me?

Thanks, T

Dr. Bermant answers:

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

Nasal obstruction can be partial, interfering only when demand is greatest. Sometimes such obstruction can really bother some individuals. Opinions and specifics for any one patient require an examination and 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. 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: Deviated Septum - Surgery?

Dear Dr. Bermant,

My wife was complaining of severe pain in her sinuses and the family doctor diagnosed her as suffering from "chronic sinusitis" and he referred her to a ENT Specialist. The ENT Specialist asked for an X'ray and confirmed the family physician's diagnosis and blamed the problem on a "deviated septum." He suggested a surgical procedure (under general anesthesia) that would correct the deviation in the septum. This surgical procedure has been scheduled for mid-January.

Subsequently, another physician has warned us against the above mentioned surgical procedure suggesting a high level of "morbidity." He also felt that it was unlikely that the above mentioned surgical procedure would provide a lasting and uncomplicated solution to the problem. He has recommended FESS (an "endoscopic procedure") instead and has asked us to see another ENT Specialist.

We're confused!

We intend to get a second opinion but we would also like to get some input from you.

Thank you,

Sincerely yours,

N

Dr. Bermant answers:

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

Unfortunately both can be right. A bent septum can push against the walls of the nose. The turbinates (the hanging humidifier tissues of the side walls) cover the openings of the sinuses. A badly deviated septum can be the cause of the sinus openings obstruction.

Other problems in the sinus openings can cause obstruction. Disease in the sinuses will not necessarily be treated by septoplasty (septal surgery). Endoscopic sinus surgery can assess and treat these problems. For this reason I usually examine my patients in the office prior to committing on the method of correction (sometimes both are necessary).

Sometimes the problem is not mechanical, but environmental. Neither surgical option will improve the reactions to allergens or irritants. Without an examination and evaluation, I am at a disadvantage compared to the doctors you have at home. 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


Question: Re: Deviated Septum

Hello,

I saw your website and tried to find information regarding septoplasty. Although I have found a lot of information about septoplasty, I can't seem to find a detailed description of EXACTLY how this surgery is performed. I know why it is done, but how? I've heard a lot of things from different people, but I would like an educated answer. The more information - the better.

If you can provide me any information, I would greatly appreciate it.

Thanks for your time.

Dr. Bermant answers:

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

Septoplasty is the name for a wide variety of surgical operations. Without an examination, which option would be suggested is very difficult. There are many surgical textbooks written on this topic alone.

Our website is meant as an introduction to plastic surgery, not a replacement for an in office consultation. Perhaps you are looking for the information in the wrong place. The web patient education sites will be limited for that reason. I cannot reproduce the detail of a text book here.

Michael Bermant, MD


Question: Re: Breathing Problems

Dear Doctor Mike,

I'm a 25 year old male. When I was 7 I was kicked in the face playing football. A deviated septum was the result. I told nobody. Nobody ever knew, not even me. My parents where too busy saving for my education.

My older cousins would yell at me for keeping my mouth open all the time. I had a reason. Several years later I went to the now head of ... plastic surgery Dr. G He postponed rhinoplasty until the age of 16. The surgery was mainly for a breathing problem, but the straightening of my nose was a nice extra.

Not breathing through my nose was a way of life at an early age. I have no memory of any different. My nose looked perfect, but I still had problems breathing. Now my breathing problems have turned into sleeping problems. I have already taken the allergists path. I have had tests done by three different allergist and six different labs. All with different results. For example one doctor had me take a 400$ food allergy test which was 100% negative, while the next sent blood to his labs in Oregon and found that I scored a 3000 IGE for eggs whites. Well I have eliminated all egg/gluten/wheat/soy/you name it. I'm living on rice and fish. I can say living 100% junk free has cleared my head somewhat, but every night my nose still swells up to the point where I can't breath. I have a humidifier, the special sheets, a hepa filter, and I have thrown out the down comforter and pillows. I was also negative on the sinus scan, scored 1's and 2's on airborn allergies. I have several physician friends, one of which I almost married. All they would do is give me another case of pills. My PC physician is taking the same route(pills). I could start my own drugstore specializing in steroidal nasal inhalers. None of them worked!

Now that my sleepless nights are causing respiratory infections(cold and flu, general annoyance with life) due to a weakened immune system my PC physician has prescribed temazepam for insomnia. "Dr., but I don't have insomnia I have a breathing problem." "You can't sleep so try this and we'll see how it works for a few days." I took one and had very strange nightmeres, although I did get the first 4 hours of continuous sleep which I can recall! I need a solution to the problem.

As far as the problem being allergy, I have no noticeable allergic reaction to any food I've ever eaten or any airborn particle. I've even tried snorting dust in my room to get a reaction while I was able to breath through my nose.

My symtoms are not complicated. Mainly during the evening hours my nose will clog. During the day I still need to keep my mouth open to breath, but the pressure is not as bad. I can almost feel it coming on. I know the problem lies external to my sinuses due to the sinus scan, and the fact that I stick tissue in my nose(My own personal packing) and when I pull it out I get relief for a few seconds. The annoyance is so great that I rather not communicate with others.(thank God for computers) Its actually more comfortable with tissue bunched up in my nose then it is without it. Although I still can't breathe, it seems to relieve the pressure. Since I can't use my nose my mouth and lungs have to take over, and they aren't doing such a hot job anymore. Its like putting a hole in a tin can of punch and pouring it over the sink. It works much easier when there is a second hole punched anywhere in the can. Well thats my story. Thankyou in advance for any direction.

J

Dr. Bermant answers:

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

Nasal obstruction is often a combination of mechanical and lining swelling obstruction. If the mechanical aspect of the problem has been optimized, then the environmental aspects interacting with the lining is the only way to help that I know of. As a plastic surgeon, I usually help with the former - mechanical obstruction.

Your story sounds like allergies may indeed be the culprit. Your doctors have the best chance of giving you the solution to the problem, they have had the chance to evaluate and examine you. Environmental allergies ARE very frustrating. It can take a "Sherlock Holmes" like mentality to find the culprit sometimes. At other times, the offending agent can not be removed and our medications that blunt the allergy effects are our only tool. Not much fun.

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: rhino problems

Dr. Bermant,

I had a rhinoplasty a few years ago. Since then my breathing has been giving me trouble. It has been very dry, going through my nose and into my throat, effecting my voice. I was wondering if anything could be done about that.

Thanks,

F

Dr. Bermant answers:

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

You could be describing a septal perforation or too much turbinate removal as well as many other possibilities. Without an examination and evaluation, it is impossible to say what could be wrong. You could go back to your operating surgeon and explore the problems. You will need that evaluation for anyone to explore the possibilities.

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: septoplasty

I was just operated on for a breathing problem. In the past , I have had three operations which all failed. Recently I was told that my breathing problem was a result of a cartilage growth in my nose. To correct it the doctors preformed a surgery which involved breaking my nose, drilling away the growth and sowing it back up. I was wondering if this is common and can you tell me what is usually done and the success rate.

Thank-you.

Dr. Bermant answers:

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

No, your descriptions does not sound very common in my experience. For most patients, septoplasty improves mechanical obstruction. Although recurrences can occur, cartilage is a fickle material and can bend in ways not desired, usually one operation is enough. Your questions are better for the doctor who has operated on you 3 times.

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: Sinus Surgery vs. Allergy Treatment

Dr. Bermant,

I just came upon your site on the Internet, and I had a question I wondered if you could help me with. I am a 35-year-old male, and I have chronic sinus problems. My ENT has recommended sinus surgery. Specifically, the ENT wants to fix my deviated septum and use a laser to shrink my turbinates. Although recent x-ray showed no sign of sinusitis, I have had recurring sinus infections for the past three or four years (as many as six or more a year).

For the past few years, I have been using Nasacort AQ spray daily. I use antibiotics regularly when infections are bad (fever, sinus pain, chills, listlessness). In fact, the sinus infections have become so chronic lately that my GP has had me on antibiotics for almost three months straight now. Claritin D usually makes my heart race, so I avoid it. An allergist tested me and said I had a rather strong allergy to dust mites. However, he recommended Nasacort and Claritin, not shots. My wife and I have a pet cat, but the allergist said I was not allergic to cat dander. My ENT asked me, half-jokingly, when I was getting rid of the cat; I told him my wife might not like that idea. I've lived with the cat for about four-and-half years now, never having been around cats before. I would say my chronic sinus problems started about three-and-half years ago. I'm not sure if one is related to the other.

This recurring problem has definitely affected my quality of life. My ENT says that on a scale to 1 to 10 (10 being the worst), my septum deviation is a 7. My septum is deviated on the right side, by the way, and I constantly feel pressure on that side of my nose (as well as in my right ear). I also have a fair amount of tearing and redness in my right eye. My ENT also says that I may have sleep apnea too (my wife says I snore nightly).

My question to you: Although I haven't been tested for allergies in a couple of years, does my problem sound structurally related or allergy-related in your experience? Or both? I'm concerned about the

surgery, because I've heard that it is very painful. But if it helps correct the structural problem, it may be worth it. I would appreciate any feedback you may have. Thank you very much.

Dr. Bermant answers:

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

If the cat is the issue, you just can't loan it to someone for a week. The house is full of material from the cat that can aggravate some problems. Do you travel or leave the home environment for any length of time? Does your problem get worse, better or stay the same when you are away from home? Is there any difference between when you are at home at night or weekends and when you are at work?

I use allergists to help me with that component of the nasal obstruction problem, your allergist should be the best one to ask specific questions about the cat. From a mechanical point of view, problems do not have to be only one or the other. Both allergic and mechanical can be components in nasal obstruction. Relief of one may improve the condition to the point of something one can tolerate, or both may need to be addressed. A good nasal surgeon will not paint a perfect guaranteed this will work picture. Unfortunately that is not reality. For my patients with similar questions, I try to call the allergist with the patient in the room and have a 3 way conversation. When not possible, I call the allergist and report the conversation to the patient. There is no guarantee this works for every problem, but at least my patients tell me they feel better about what ever decision is made.

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: Septal Deviant

Dear Dr. Bermant:

When I was in the 7th grade (I am now 44) I was in a fight and broke my nose. Actually, Aubrey ... broke my nose, but I started the fight and I deserved everything he dished out. I digress.....I have been told by my internist that I have a deviated septum and that I have openings in my nasal passages that do not encourage good drainage and mucous collects and that is the reason that I have 2-3 sinus infections a year. In fact, I can barely breath at all out of my right nostril.

I sometimes breath heavily at night (my wife calls it snoring), particularly when I am very tired. The Dr. suggested that I consider a 1) Nasal sepal resection, 2) Sub mucous resection of Inferior turbinates and 3) Electrocoagulation of inferior turbinates. I am under the impression that this surgery would straighten the septum and open the drainage channels and improve breathing considerably.

I understand that there may be new methods of nasal surgery that use laser techniques and can be done as an outpatient. I understand that his surgery is not only faster but is less strenuous than the traditional scalpel, general anesthesia surgery and heals quicker. I assume that it is also significantly less expensive than a stay in the hospital.

Is this true or did Aubrey's blow to the head in the 7th grade also affect my brain?

J

Dr. Bermant answers:

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

Your story certainly sounds like you are suffering from nasal and sinus obstruction. Almost ALL nasal surgery is done as an outpatient. I do not know why someone is trying to scare you into a higher cost operation. The scapel is just fine for doing such surgery. The laser is a fine cutting tool but brings little advantage to most nasal surgery. It is a very expensive tool and there is much hype to justify the cost or to try to "separate" that surgeon from the crowd. A laser does coagulate as it cuts. Turbinate cauterization can benefit from the laser but not to the degree to justify the added charges I have heard of. I really wish there was a way to separate market hype from real benefit. And yes, I know how to use the laser for my own cases. This is not "sour grapes" from a "non-user". I just have not seen the major benefits to push its use in this situation. I have never seen a laser wound heal quicker than a scapel wound nor have read any studies suggesting that advantage. A laser can be used to burn the turbinates just as a cautery burns them. When used in this fashion, there also will be no advantage. If a laser is used to cut instead of a cautery, there is less thermal damage. In most cases the difference is too trivial to justify the added cost.

I certainly hope that Aubrey's blow to the head left only the nasal / sinus obstruction problems. Good luck on your continued education into the risks, benefits, and alternative methods of care.

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


Hello Dr!

I find your message boards very  intuitive and very
useful.  Please keep up  the good work!

Today is Sunday, July 4th.  It's been almost 5 days since I had my rhinoplasty, spetoplasty,  and turbinectomy performed (Tuesday).  The nasal obstruction was done on the right side of my nose.  I had the packing removed the following day.  It's been almost 5 days since the surgery.  I still have a splint on my nose, and splints on both sides of my septum.  I can breathe very well on the left  side of my  nose.  However, I'm having complete difficutly breathing on the right side of the nose.  It seems my right side is completely block.  Hardly any air coming in or out.  I tried using Afrin to improve my breathing, with no avail.  I notice the right nostril had very small air passage as compare to my  left nostril.  Is this normal? Why  is it that I can breathe freely on the left side after having the packing removed, but the right side is still clogged? If this is because of swelling, how long (customarily) does it take to have the air passage normal to my left nostril?  Since the packing was removed, does the splints on  both sides also affecting my  breathing?  Also, how long should the splints be in my nose?  This is affecting my sleep so much that I am really worried.  I have a doctor's appointment on Tuesday, since Monday is a holiday (4th of July).  I was hoping to hear back from you before I see my doctor on Tuesday.

Thank you in advance!

Dr. Bermant answers:

Swelling and nasal obstruction after surgery depend on many factors best described by the doctor familiar with your surgery. I can answer such questions for my own patients, and do even on holidays. I rarely use packing any more and work very hard to maximize the comfort of my patients during and after surgery. Picking your doctor can be important. If the problem is bad enough to question another doctor on the holiday, why are you not calling your own? Hope you feel better and have a nice holiday.

Michael Bermant, MD
Board Certified
American Board of Plastic Surgery

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