Deviated Septum vs. Bump on Nose

What is the difference between a deviated septum and having a bump? Can you repair one without repairing the other and why is it best to correct both simultaneously?

Patients often ask me if their deviated septum be fixed at the same time as having a bump removed from their nose or even having a full rhinoplasty?  The short and simple answer is, “Yes, a deviated septum can be repaired at the same time as removing a bump from the nose or having a full rhinoplasty.” 

In fact, I think it is essential to fix a deviated nasal septum anytime a bump is being removed from the nose.  The “bump” on the nose is made bone and cartilage.  The top of the bump is hard and is due to an elevation of the nasal bones, either from an old fracture or simply due to the natural shape of one’s nose.

The lower part of the bump on a nose is made of cartilage - of septal cartilage.  If the nose is crooked or off center, it is often due to a deviated nasal septum.  The nose can also be off center due to broken nasal bones, broken septal cartilage, a congenital deviated nasal septum, or a combination of all of these.

For this reason – the fact that a bump is made up of septal cartilage – a deviated septum should be addressed at the time of a nose job involving lowering a nasal bump, especially if the nose if off center.  It will not be possible to improve the crooked nose without doing a septoplasty!

People often ask if doing a septoplasty at the same time as a bump removal or rhinoplasty makes the recovery longer or more difficult and the answer is “NO”.  When a bump is removed or a rhinoplasty is performed, there are required incisions in the nose to gain access to the nasal anatomy.  These are the same incisions used for a septoplasty.  The swelling inside the nose after removing a bump is almost the same as having a septoplasty so the recovery is relatively the same.

In fact, when removing a bump and performing a rhinoplasty, the nose often becomes smaller because most people want to make the nose less pronounced and more refined.  This decreases the internal diameter of the nasal cavity making the nasal airway relatively smaller.  Therefore, it is essential that any nasal obstruction should be corrected at the same time of the nose job to maximize nasal airflow.

I strongly feel functional nasal surgery in intimately intertwined with cosmetic surgery of the nose.  I want the nose to look - and function - the best it can.  If people suffer from chronic sinusitis and nasal obstruction as well as wanting their nose to look better, it is prudent to perform the functional endoscopic sinus surgery, the septoplasty, and the nose job or rhinoplasty at the same time.  The functional nasal surgery, correcting a deviated nasal septum and chronic sinusitis, can and should be done at the same time as bump removal and rhinoplasty.

The recovery involves wearing a splint for six days, minimal to moderate bruising around the eyes and cheeks, and no packing that needs to be removed.  I rarely use packing as a dissolvable suture is used to hold the tissue together and reduce swelling.  All sutures used are generally dissolvable.  Patients almost never complain of significant pain after surgery.  The most common complaint is a stuffy, congested nose, even when the airway has been improved with a septoplasty or turbinectomy.  Tissue swells after any operation and the same occurs inside the nose.  Additionally, there is often mucous and dried blood in the nose which I will gently remove six days after surgery when the splint is removed.

Patients are happy when their nose looks the best it can, appears natural, and functions properly.  For this reason, it is important for the nose surgeon to do a careful preoperative assessment of the functional issues with a CT scan, use computer imaging and an open conversation to assess the specific cosmetic goals, and perform a well-executed, thoughtful and precise functional and cosmetic nose operation.