As a facial cosmetic plastic surgeon in Charlotte, I consider rhinoplasty surgery one of the most common and a favorite procedure that I am lucky to perform on a daily basis. When my patients are considering a nasal refinement surgery, I discuss that the nose not only has a form or aesthetic that we will improve, but the nose has a central function in our everyday lives, breathing. During breathing, the nose is the area of the breathing passageway that has the highest level of resistance. Decreasing the resistance of breathing in the nose can greatly improve the quality of one’s life. Chronic nasal obstruction can cause:
2) Limit exercise ability
3) Hypo-nasal voice
4) Predisposition for sinusitis
6) Poor sleep
During my intern and residency training in head and neck surgery, I was able to focus and concentrate on the function of the nose and breathing. I learned to identify the multiple locations where breathing is commonly obstructed in the nose, and the best procedures to correct them.
In evaluating patients with nasal obstruction, it is most important to identify the cause. There are 3 main causes of nasal obstruction: medical, anatomical, or both.
Common medical causes of nasal obstruction are:
2) Chronic sinusitis
3) Medication induced (rhinitis medicanmetosa)
If patients have medical causes of nasal obstruction, they have to be properly treated with medications to improve breathing out of the nose. If they are not properly treated, then any surgery to improve breathing will be limited as part of the cause is not corrected.
The nose is composed of an underling bone and cartilage framework that is enveloped by muscle, fat, and skin. There are multiple anatomical areas of the nose that may contribute to nasal obstruction. In the evaluation of a patient with nasal obstruction for rhinoplasty, the anatomical obstruction may be one location or many locations. The common anatomical areas responsible for chronic nasal obstruction are:
1) Deviated septum
2) Hypertrophies turbinate
3) Collapsed internal nasal valve (Highest area of resistance in the entire airway!)
4) Collapsed external nasal valve
After identifying the anatomical cause of the nasal obstruction, the surgical treatment plan can be created. It is during this time as a facial cosmetic plastic surgeon, I can create a plan that will not only improve your breathing, but will also improve your facial harmony. During a rhinoplasty procedure in Charlotte, the nose is weakened in some areas and strengthened in other areas to build a nose that will last a lifetime.
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.
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.
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.
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.
6849 Fairview Road Suite 200, Charlotte, North Carolina28210
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