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Robert Singer, M.D., FACS
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9834 Genesee Avenue
La Jolla, CA 92037 - Tel: Click for phone number
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- www.rsingermd.com
Answered Questions
Q:
Is it common to do a rhinoplasty with septoplasty?
I have a deviated septum that has caused a host of other problems (breathing, headaches, fatigue, hard mucus, infections inside). If I were to get a septoplasty, would it be normal to ask for reshaping? Would it most likely or less likely be covered by insurance? If not, about how much extra would it be?
A:
An external rhinoplasty and an internal correction of the airway, including a septoplasty, are frequently performed together by good experienced rhinoplasty surgeons. The best nasal surgeons deal not only with the external aesthetics, but also with the internal function. Every insurance company’s approach to reimbursement is different. Many will pay for a portion of the septal surgery, but not the cosmetic aspect of a rhinoplasty. A full consultation with an experienced expert rhinoplasty surgeon is the first place to start and a prior authorization letter can help delineate what may or may not be covered. That can minimize the number of surprises you get with regard to reimbursement.
Robert Singer, MD FACS
Q:
Is possible to fix a crooked nose placing fat?
I had a revision rhinoplasty. A graft was used to fix the over resected dorsum, but this is now moved to the left, I think it is too big for my nose, because I can feel it almost almost in my forehead, between the eyes brows. Is it possible to fix it placing my own fat and make it look not so crooked or is necessary to go under a third rhinoplasty?
A:
Is it possible to fix a crooked nose placing fat?
What is paramount is seeking an experience rhinoplasty surgeon for any additional revisions. Evaluation to determine the best option for correction should start with a full nasal exam by an experienced expert who is certified by the American Board of Plastic Surgery who is ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) or an ENT doctor certified by the Board of Otolaryngology. It may be useful to bring in prior photos as well as fully discussing your desired outcome and what is realistic. There are many options available and fat has a role as a filler for mild depressions. It is generally thought that 50-70% of the fat remains permanently. Fat, however, is not adequate if you need additional structural support which would require cartilage or bone grafts. If a cartilage graft was placed and is too big or displaced, it may require a revision or trimming of that graft rather than just placement of fat which may make the nose look larger. Healing may take longer to occur in a revision rhinoplasty.
There are permanent synthetic fillers,,but they have significant greater long term problems and I would not suggest using them in the nose.
Robert Singer, MD FACS
Q:
Are ENT doctors who are ABPS members a good choice for rhinoplasty?
In researching specialists for a rhinoplasty, I have come across many ENT docs who are certified by the board of Otolaryngology and also by the American Board of Facial Plastic and Reconstructive Surgery, but not by ABPS or ASAPS. It seems like many specialize in rhinoplasty. But I am wondering if they are qualified enough. Similarly, I wonder if someone who has ABPS certification, but is not an ENT, is a suitable choice.
A:
Are ENT doctors who are ABPS doctors a good choice for rhinoplasty?
Rhinoplasty surgery is a combination of art and science. It ideally encompasses an aesthetic approach to the external appearance with a functional concern for the nasal airway. Good rhinoplasty surgeons are knowledgeable in both aspects. There are excellent nasal surgeons who come from both disciplines: Plastic surgeons certified by The American Board of Plastic Surgery who are ideally members of the American Society for Aesthetic Plastic Surgery (ASAPS)and ear, nose and throat doctors who are certified by the American Board of Otolaryngology and additionally by the American Board of Facial Plastic and Reconstructive Surgery. Beyond the appropriate training, what is essential is a sense of artistry and experience. Ask the surgeon how often he or she performs the procedure and discuss both the desired outcome and what is realistic.
Robert Singer, MD FACS
Q:
Is fixing a deviated septum more complicated after a primary rhinoplasty?
Is it more difficult to correct a deviated septum after one has already had a rhinoplasty for aesthetic purposes to correct a nasal bump?
A:
Is fixing a deviated septum more complicated after a primary rhinoplasty?
It is usually not, but it depends on your particular anatomy and what was done surgically on your nose previously. The best way to approach this is to have a consultation with a fully trained surgeon certified by the American Board of Plastic Surgery who is ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) or an ENT doctor certified by the Board of Otolaryngology. The surgeon should have extensive experience in performing secondary nasal surgery.
Robert Singer, MD FACS
Q:
Artefill in Nose
I have developed granulomas on my nose after my last revision rhinoplasty. I believe these are from the Artefill I had injected a few years ago as I am getting these raised bumps. Please help what can I do as I am so depressed. My last rhino revision looked so nice to start off with and now I do not even feel comfortable going out in public also due to the redness.
A:
Artefill in the nose?
The correction of what you describe may be simple or complicated depending on the extent of the raised bumps and their location. Occasionally, these can be treated with a small injection, but often they require a more extensive surgical excision which may or may not remove all of the Artefill. Artefill is a permanent filler that is comprised of polymethyl methacrylate (PMMA) and bovine collagen. Most experienced knowledgeable rhinoplasty surgeons would not suggest using synthetic permanent fillers in the nose because of the long term problems that can develop, even years after these injections..
Robert Singer, MD FACS