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Explore what others have to say about Rhinoplasty Plastic Surgery of the Nose 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

Subj: Re: nose

Hello,
I was trying to find info about a deviated septum and came across your site. Would you possibly be so kind as to tell me something?? How dangerous and STUPID is it to snort cocaine? I've noticed a very big hole in what use to be the bone? between my left and right nostrils. I realize this is probably beyond your normal purview, but I can't seem to find an answer anonymously anywhere. I'd like to know the worse case scenario - can cancer form from abuse or a nose cave in or ? Thank you.

Dr. Bermant answers:

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

A hole in the septum is a common complication from cocaine abuse. The drug may make you high, but it is also a potent vasoconstrictor (makes blood vessels contract). The hole also no longer has tissue to absorb the drug so other areas get affected. As enough support is destroyed, the nose can collapse.

Your nose is designed for breathing and protecting your lungs by humidifying the air. As you destroy the lining of the nose, these functions do not take place as well. Other complications can result. Your best choice: stop the drug.

Some septal holes can be reconstructed. Only an examination by a competent surgeon ENT or Plastic who is comfortable in this region will be able to tell you if surgical intervention will be of benefit.

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

Subj: Re: nose

Dr. Bermant,
Thank you very much for taking the time to reply. The info was quite informative and will add to my arsenal of things to help me quit!

Good luck
Michael Bermant, MD


Subj: Re: perforated nasal septum

After using rhinocort nasal spray for a year to treat allergies, I have a huge hole in my septum which seems to be getting larger. I am seeking information on treatment of same. Can you help? thanks,

Dr. Bermant responds:

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

Septal perforation (hole in septum) is a rare complication of nasal steroids (rhinocort). You should have your nose reexamined by your physician and investigate if the steroids should be discontinued. I would need a more extensive evaluation and examination of you to make any clinical recommendations.

Nasal perforations can cause some problems. Holes just the right size can cause whistling. As mucous gets into the hole, the size becomes smaller. The change in size can be the reason for intermittent whistling. Some holes bother patients with crusting that can be minimized with saline nasal sprays.

Small holes can sometimes be reconstructed with local tissue. Other holes can be occluded by a special plug. Many times the hole can just be left alone.

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


Subj: Re: my nose...

hi doctor, i had surgery for a deviated septum three yrs. ago. about one yr. later, i noticed a hole in my septum about right where one would put a nose ring. (i wouldn't!) the hole was the size of a pin head with a smaller one right above it. i went to the doctor who performed the surgery, and she said it was a suture hole. i went to another doctor to get another opinion. i decided to have surgery to fix the hole with the second doctor, and he did a tip graft. after surgery, he told me that he didn't need cartilage from my ear for the tip graft, because he used the cartilage from my deviated septum. i was shocked, and reminded him that i had had deviated septum surgery 3 yrs. prior. he said he saw no evidence of that and that i was very blocked on the left side. i'm relieved that i finally know how a normal nose breathes, however, did the first doctor do her job? can septum grow back, or be partially fixed? i don't understand what she did besides leave me with a deviated septum and two holes in my nose!! i'd appreciate your feedback.

Dr. Bermant responds:

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

A bent septum can be straightened with a septoplasty and submucous resection. Either operation if done reasonably results in ability to breath through the nose after the swelling resolves. If you never were able to breath well, your first surgery was probably not very effective or only partial in nature.

In a septoplasty, the bent material is reconfigured and modified to move it back into a more central position. Unfortunately cartilage is fickle material and the deformity can come back. In this case there would be cartilage material for grafting.

In a submucous resection, the offending deflected cartilage is removed just under the cartilage forming layer. This maneuver can open the nasal breathing passages nicely. Cartilage can reform from the cartilage growing layers (perichondrium), this often is not very thick and may not be a good source of graft. Obstructive deformity recurrences can also occur.

A hole in the septum can be a common complication of septal surgery. Removing cartilage and leaving the two layers of mucosa / perichondrium behind can result in such a hole. If the hole is located too close to the nasal opening, it can look bad. Otherwise most holes do not cause problems unless they are just the right size. Air going by a hole the right size can cause whistling. Larger holes that normally do not cause problems sometimes plug up partially causing intermittent whistling. Reconstruction can be by moving tissue around and or grafting.

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


Subj: Re: My Nose

Hi. I would like to get your advice. I aM 28 YEARS old and just had my second rhinoplasty performed this past May. First surgery was for cosmetic reasons when I was 15, my second surgery prevailed after a flight to Hong Kong,I got off the plane and my nasal passages were completely obstructed. I went back to my original surgeon who said he would perform the surgery free of charge. Over the years prior I developed a perforation in my lower septum. He thought that was the problem, I had surgery which closed the perforation with a graft from my inner ear. Three months later, I still cannot breath easily, sometimes not at all. I can't sleep and people sitting next too me can hear my breathing. Breathing is labored and tiring for me. I have been back to my Doctor at least four times without scheduled appointments. He has given me 2 steriod injections in my turbinates thus far although this did not help. I am on claritin D which helps temporarily but keeps me awake ( insomnia side effect). I would like to get another opinion. should I request my records?? Is this normal or could it be malpractice? Please advise.

signed,

Desparate

Dr. Bermant responds:

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

Nasal obstruction can be from many reasons, most of them impossible to determine over the Internet. An examination and evaluation would be the best way to go. You have been back to your doctor, what is your doctor's best guess for the continues problem? Allergies can obstruct the nose. Surgery can not improve the reaction of allergies. Surgery can improve mechanical obstruction. Sometimes a slight allergic reaction can close off a partial obstruction.

Septal perforations can sometimes change the pattern of airflow in the nose enough to cause crusting and then obstruct the airway. Other materials can irritate the lining of nose aggravating the problem. Placing materials in the nose can cause septal perforations. Although we sometimes use cocaine to dilate the nasal passageways, chronic use has caused perforations and obstruction.

Rhinoplasty and creating a very small nose can reduce the nasal air passages. If the internal valves have been made very sharp, spreader grafts can improve airway obstruction in such cases. Collapse of cartilage like the lower laterals and upper laterals which form the support for the outer walls of the nose can also interfere with the airway. If pulling the cheek to the side improves breathing, this may be part of the problem (or that the septum continues to be an issue).

Airway obstruction is one of the risks of rhinoplasty and in itself not malpractice. It also sounds like your doctor has gone the "extra mile" for you. Records are always valuable for any good 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


Subj: Re: septal perforation after septoplasty and endoscopic sinus surgery

HI DR.

I underwent a septoplasty surgery to streaghten it and endoscopic sinus surgery to open up the sinuses because I had 6 sinus infections in one year. I came to during the surgery and bleed while the septal splints were being but in. my ent had to pack my nose for 3 1/2 days. Very bad experence.

Anyway, after the packing came out my allergist ( my allergies are pretty bad) noticed dimples in my septum. He said they weren't eather good or bad if they didn't bother me. Well 3 months after the surgery I developed a whistle while I breathed. It would not go away. I called my ent who saw a pin tip sized hole in the membrane behind which he had removed cartledge to streaghten my septum. He said He'd cautorize it to generate new tissue growth. It did not it made the hole bigger. He cautorized it again and it got even bigger. Now I have a 7mm silicone Kartush tm patcher in the hole which is uncomfortable and crusts up regulary. The whistling has stopped but now my septum is sore and I live everyday wondering if it will fall out. My septum without the plug is unbelievably uncomfortable to live with. I understand that there is a surgery that is 90% effective in treating septal perforations. I hate the thought of having to go through another surgery but the thought of having this silicone up my nose for the rest of my life does not appeal to me either. This whole experence has got me quite upset. I go in for help for one problem and I come out with an even bigger problem. What would you recommend that I do?

Dr. Bermant responds:

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

Your discomfort during nasal packing is common, that is why I strive to only use the packing when essential for the operation. Septal resection involves the removal of deformed cartilage that obstructs the nasal passages. Sometimes a hole develops between the two nostrils. If the hole is just the right size, a whistle sound is created when air goes over the hole. If the hole gets smaller or larger, the sound stops. A large hole also disrupts the airflow in the nose creating annoying crusting and drying. The Silicone plug is a very good way to make a new wall. Moving tissue from one place to another in the nose (a flap), in some cases, can close the defect. Without an examination and evaluation, I cannot comment what might be reasonable treatment for your problem.

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


Subj: Re: Perforated Septum

My wife has a perforated septum due to several reconstructive nasal surgeries. Her nose bleeds quite easily and frequently even though she has been careful in not applying undue pressure or touching the area. Despite keeping the nose lubricated by applying vitamin E and/or A & D ointment, bleeding still occurs and the perforation has not healed. Any suggestions would be greatly appreciated? Thank you.

Dr. Bermant responds:

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

Septal perforations that are large enough disrupt the normal flow if air in the nose. The larger holes also disrupt the normal flow of mucous over the surface. Crusting, fragility of tissue, bleeding and discomfort can be the result. Lubrication and humidification seem to help most patients. The single best action you can take is to have an evaluation by a doctor who treats such problems. Without the exam, I cannot advise what would be best. Sometimes a plug from soft plastic helps. In other patients reconstruction is possible.

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


Subj: Re: cocaine and septum

I have done snorting of cocaine for 7 months almost daily Friday Dec. 12th, my doctor said when he shines the light in my nasal, he thinks there is a small hole, there is also a black area. He says I need detox which I know, but what about my nose?

G

Dr. Bermant responds:

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

Cocaine abuse in the nose frequently results in a septal perforation (hole in the wall between the two nostrils). Please see other posts here and soon a page on septal perforations for further information. Better yet detox and get a consultation with a board certified Plastic Surgeon. Stopping now may let the injured tissue heal before the hole develops more.

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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