Posts Tagged ‘deviated septum’

How To Correct A Crooked Nose

Tuesday, November 6th, 2012

 How To Correct A Crooked NoseTo improve facial harmony, many times patients seek rhinoplasty surgery in Charlotte to straighten a crooked nose.  Absolute facial symmetry is not a goal of facial aesthetics as everyone has minor differences between the two sides of the face.  This is true when evaluating the facial features of supermodels, Tom Cruise, Brad Pitt, and Carmen Electra.  When people have obvious facial asymmetries, the eyes of onlookers are focused away from the eyes and smile to the obvious facial asymmetry.  One of the most common obvious facial asymmetries is a crooked nose.

A crooked nose will take attention away from a person’s beautiful smile or gorgeous eyes.  In evaluating a person with a crooked nose, it is important to understand the cause.  Common causes of a crooked nose are:

1)     Result of trauma:  History of a fight, car accident, or strike to the nose

2)     Congenital:  Patient born with a crooked nose

The nose is composed of bone and cartilage that is covered with skin, muscle, and fat.  The top part of the nose is the bony part, and the lower flexible part of the nose is the cartilage.  In evaluating a crooked nose, I first identify if the bone, cartilage, or both parts of the nose are crooked.  If the bone is crooked, osteotomies (breaking the nasal bones) must be done to straighten the nose.  If the cartilage is crooked, then other rhinoplasty techniques must be performed.  Typical procedures that may be performed to straighten the cartilaginous portion of the nose are:

1)     Septoplasty- Correcting a deviated septum

2)     Swinging door technique-  Correct a deviated septum at the entrance of the nose

3)     Spreader grafts-  Improve breathing, build of the nose, and straighten the nose

4)     Onlay grafts-  Re-build  a collapsed section of the nose to increase symmetry

5)     Columellar strut-  Help straighten a deviated tip

6)     Tongue and groove-  Powerful technique to straighten a deviated tip

As you can see, there are many techniques that I use to straighten a crooked or deviated nose for my patients in Charlotte.  I may have to use 1 or all of the above techniques to create a nose that is straighter and allow a patient to be able to easily breath for the rest of their lives.

Deviated Septum: The New Reason for a Nose Job?

Thursday, May 10th, 2012

Hollywood’s stars are privileged in many ways, one of which is the ability to stave off Father Time. How do they do it? With access to trainers, diet gurus, luxurious vacations, expensive cosmetics, and of course, world-class cosmetic surgeons. Yet many deny having had “work done” or cite excuses like a “deviated septum” for getting a nose job. Is a deviated septum really a good excuse to sculpt a new nose in the Charlotte area?

What is a Deviated Septum?

The nasal septum is the thin wall between your nostrils, separating the right and left nasal cavities (hopefully) in equal parts. According to the Mayo Clinic, a deviated septum occurs when that thin wall is displaced to one side. Such a displacement can actually cause a bit of trouble, leading to reduced air flow, difficulty breathing, nosebleeds and other pesky symptoms. Snoring may be linked to a deviated septum.

What’s the Big Deal?

So you have a deviated septum. What’s the big deal? You might get a little less oxygen, but does that really matter? Actually, yes. Oxygen is one of the key components to your health. You breathe because all your cells need energy, which is made in part with help from the oxygen molecule. Getting less oxygen or struggling to take it in everyday can actually have an impact on your energy levels, brain activity and more. You probably don’t even think about breathing until it’s difficult. When your nose is stuffed due to a cold, it has a big impact on your day, doesn’t it?

Symptoms of Nasal Obstruction

If you have a deviated septum, you might not notice. Many of its symptoms you may just “live with,” thinking they are linked to allergies or other health factors. The Mayo Clinic lists difficulty breathing, especially during a sinus infection or allergy season. You can also experience facial pain, frequent nosebleeds due to nasal dryness, frequent and recurring sinus infections or noisy breathing during sleep.

Treating a Deviated Septum

You can manage a deviated septum with nose strips that open your nasal passageways. However, the only way to treat the condition is with cosmetic surgery. So, a nose job is necessary to correct the problem.

How Common is a Deviated Septum?

According to one statistic, approximately 80 percent of all nasal septums have some deviation. This problem, however, typically goes unnoticed. If it does impact your life in Charlotte and your health, surgery to correct the deviated septum may be essential.

The Doctor as the Patient: My Septoplasty for Nasal Airwary Obstruction Procedure

Friday, February 10th, 2012

You know how they say doctors never take care of themselves?  Well…. I am guilty as charged.  Although I exercise almost everyday, recently ran a half marathon with my fiancee, eat well, and try to get plenty of rest, I have never been able to breathe out of my nose properly, which I have ignored for quite some time. Eventually, I started to convince myself that there was a slowly growing tumor in my nose.  Physicians are also slight hypochondriacs, of which I am obviously also guilty, due to the fact that I started to truly believe I had a tumor in my nose.  A tumor would have been an extremely rare cause of nasal obstruction, but it is the most serious type.  I happened to be in the CT scanner room one day at my office, and I thought it would be good time to identify the cause of my deviated septum.

Dr. Jonathan Kulbersh’s CT scan:

ctblogpic 1024x577 The Doctor as the Patient: My Septoplasty for Nasal Airwary Obstruction Procedure

Deviated Septum Causing Complete Nasal Obstuction (Dr. Kulbersh's Poor Nose))

On a CT scan, the left and right side are switched.  The green diamonds represent the eyes and the yellow diamond is over the brain.  The blue arrow shows the open nasal passageway on the left side and the red arrow shows the deviated septum causing complete nasal obstruction (on CT scans black is air, grey is tissue, and white is bone).

A CT scan is an unnecessary test to diagnose a deviated septum.  A deviated septum is easily diagnosed by a qualified facial plastic surgeon.  I was relieved to know my deviated septum was the cause of my nasal airway blockage, and it was not blocked by a tumor. I was also relived to find out that my breathing could be fixed from a safe surgical procedure, septoplasty.  My first step to fix my deviated septum was to find a qualified cosmetic surgeon, Dr. Babak Azizzadeh. Even though I am a facial plastic surgeon specialist myself, I still had a consultation with my doctor.  We went over the risks, benefits, alternatives, and location of the septoplasty.  After gaining complete trust from a great first consultation with Dr. Babak Azizzadeh, I moved forward with the septoplasty surgery.

The septoplasty surgery was yesterday, and was my first time being on the “other side of the table”.  Even though I am a facial plastic and reconstructive surgeon and have done this procedure many times, I was still nervous before the surgery.  When I showed up at the outpatient surgery center, I was greeted with a very warm welcome, which eased my anxiety. I was taken into the bathroom, where I changed into a gown, socks, and put on a hat.  I was then placed in a patient room and welcomed by a very friendly nurse.  She asked me a variety of medical questions, and then placed an IV into my arm.  Unfortunately the first IV was not placed in the vein properly, and the anesthesiologist had to administer the IV in my other arm.  When the anesthesiologist placed the IV, he first numbed the area with lidocaine and this technique was much more comfortable.  After the painful experience with the first IV, I will now insist that all my patients receive lidocaine before their IV’s.  After the placement of the IV, my doctor came into the room to answer any of my last minute questions and concerns.  The anesthesiologist then gave me a medication, Versed, to relax my nerves, and I was taken into the operating room.  All I can remember is the anesthesiologist placing oxygen on my face, and then the surgery was over.  (I was told later that I was feisty waking up from surgery!)

Immediately after waking up, I could feel slight pain in my nose.  I told the nurse about the pain, and she immediately gave my an IV pain medication that resolved the pain. Within one hour, I was feeling better and ready to go home.

post op The Doctor as the Patient: My Septoplasty for Nasal Airwary Obstruction Procedure

Dr. Jonathan Kulbersh with Nasal Bandage in Place

I am always honest with my patients, and I would say last night was uncomfortable.  I was not in pain, but I could not breath out of my nose because I have silicone nasal splints in my nose.  Therefore, I was breathing through my mouth, which became very unpleasant.  My nose slowly dripped small amounts of blood throughout the entire night.  If it says anything about the experience, I am writing a blog post about it the next morning!

Being the patient for a facial cosmetic plastic surgery procedure was a valuable experience.  As physicians, we are striving to understand our patient’s needs and concerns.  There were many little events yesterday that created a trusting environment that improved my surgical experience. The quality of the nurses, the doctor’s extra few minutes he took to answer my questions and the staff’s initial warm welcome got the day off to the right start.  For me, most importantly, I also now know the importance of the doctor spending a few moments with the patient before surgery for reassurance.  Additionally, my cosmetic surgeon called me the evening after the surgery to ensure I was doing well.  I learned many valuable lessons over my surgical experience that I hope to use to improve the experience for my patients in the Carolinas.

I am a facial plastic and reconstructive surgeon that trained in Beverly Hills.  I have two offices in the Carolinas, Charlotte and Columbia, serving the Dillworth, Ballentyne, Southpark, Meyers Park, Eastover, Lake Norman, Huntersville, Irmo, and Lexington.

My Friend Said She Had a Deviated Septum Repaired – Does That Mean She Had a Rhinoplasty/Nose Job?

Monday, February 6th, 2012

Everyone has a friend who has had their deviated septum repaired.  Many times, people assume this means their friend had a nose job, also known as rhinoplasty, or used their deviated septum as an excuse to have a nose job, but this is not true.  The septum is composed of both cartilage and bone and separates the right and left nasal passageways.   If the septum is straight, then the air can freely flow through the nose.  If the septum is off to the side, which is a deviated septum, then the passageway can be narrowed, which causes nasal obstruction.  There are many causes of nasal obstruction with a deviated septum being one of the most common causes.  It is important to see a rhinoplasty or nose specialist in the Charlotte or Columbia area to ensure the correct diagnosis and treatment of nasal obstruction.

If the deviated septum is identified as the cause of the nasal blockage, then a short, minimally-invasive procedure, septoplasty, can be performed as an outpatient surgery.  During the procedure, all of the incisions are hidden in the nose and the majority of patients will not require any packing in the nose.  The recovery time is only a few days and patients are then back to their normal routine.  Their breathing will improve over a few weeks after the swelling inside the nose resolves.

Many times patients undergoing a nose job will have a septoplasty simultaneously to improve their breathing or to collect the cartilage to be used during the rhinoplasty, which is used to help support the nose.  Patients can undergo a septoplasty to repair a deviated septum in order to improve their breathing without having a nose job or patients can have a nose job without having their septum repaired.  So, next time your friend says they had their deviated septum repaired, do not assume that they had a rhinoplasty.

Dr. Jonathan Kulbersh is a Board-Certified Head and Neck Surgeon and is fellowship trained in facial plastic and reconstructive surgery.  His practice, Carolina Facial Plastic Surgery, sees patients in his offices in Charlotte, North Carolina and Columbia, South Carolina serving the Southpark, Meyers Park, Eastover, Ballentyne, Huntersville, Irmo and Lexington areas.