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Steven M. Denenberg, M.D.
Dr. Denenberg's articles on Medium.com.
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The nasal septum is the wall that divides the inside of the nose into a left airway and a right airway.  When the septum doesn't sit in the middle, it can obstruct airflow through the nose instead of guiding the airflow.  We then call it a "deviated septum," and that deviated or crooked septum can be straightened during a rhinoplasty.

Most commonly, the deviation of the septum cannot be seen from the outside of the nose.  The deviation that obstructs the airflow is deeper inside the nose, where you can't see it.  This patient's septum was so bad that you could see it before surgery.


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"I would highly recommend traveling to Omaha to see him. "
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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
Get that advice for your own situation by emailing your photos to Dr. Denenberg.

Questioner: Getting the Best Results Possible?
I am interested in a primary rhinoplasty and am considering flying to LA from NY. What problems can I encounter by doing my rhinoplasty in another state? Open Or closed? The doctor I'm considering does closed. I have attached my photos, Do you think I would have a better outcome with open?My nose has a deviated septum, very assemtrical thin skin, tilts to side. My doctor sug. Spreader graft does it show through thin skin? How can I be certain my nose will not collapse? Is ENT doctor necessary?
(Questioner submitted photos)

Dr. Denenberg's answer: Select your doctor well, then let him make most of those other decisions
The fact that you are considering traveling is not a problem. About 50% of my patients travel to see me.  If your care is good, you would be able to go home after the splint is off in about a week. Many of my patients go home a day or two after surgery, and then come back to have the splint removed.
See the Web reference link for a digital modification of your profile. I deprojected your tip, bringing it back closer to your face, raised the tip a small amount, and took down the gentle hump along the bridge. Digital modifications are important, because they let you see what the surgeon has in mind. You need to see whether his plan fits with your idea of what you want for yourself, and the computer imager is an excellent tool for that.
Considering the question of open vs. closed, spreader grafts vs. none, or ENT doctor: you do best to choose your surgeon by looking at his before and after photos. See whether he has been able to accomplish for other people what you want for yourself. That's mandatory. If he has, then let him decide whether to put spreaders in, and whether to do the operation open or closed.
In cosmetic surgery, you have the chance to evaluate your doctor, by looking at his photos. Once you've done that, don't micro-manage the experience: you liked his photos because of the good judgment he exercised on other people -- trust him to exercise that same good judgment on you, once you and he have agreed on a surgical plan.

Link to this question on RealSelf.com