Ask an ENT surgeon: deviated septum and rhinoplasty recovery

Here at Top Doctors, we took the opportunity to ask one of our top ENT experts who specialises in nose surgery Mr David Roberts, about two different hot topics: the causes of a deviated septum and recovery after having a nose job.
 

How do you get a deviated septum?

The most common reason for a deviated septum is the way that the facial skeleton develops and grows as you're maturing as a child and as a teenager. The septum won't finished changing until you have reached facial maturity, which is usually between the ages of 16 and 17. Often there is some subtle facial asymmetry that can lead to the septum deviating as it's developing.
















 

What are the causes of a deviated septum?

The next commonest causes would be trauma and/ or a relatively minor childhood injury, which can set the septum growing off in the wrong direction. We see traumatic cases of sporting injuries and road traffic accidents, which produce injury to the nose. This then fractures the septum and cause it to deviate and leads to nasal obstruction associated with that structural abnormality. The idea of correcting septal deviations is primarily to try and reposition the cartilage and bone of the septum so that it sits as central in the nose as is possible. This very much involves a repositioning rather than any resection of tissue. The modern septoplasty tends to be a very conservative operation, preserving the strength of the nose as a consequence. It is also primarily about repositioning the deviated bone in the cartridge and sewing it into place. We then allow things to settle down to reconstruct the structure of the nose.
 

If someone has had a rhinoplasty, how long does recovery take?

Rhinoplasty recovery is an involved process. It is certainly something that patients need to consider carefully before embarking on this sort of surgery. The initial recovery is whilst you have the plaster cast on your nose and often some stitches related to the type of approach that is used. The cast and stitches stay with the individual for a week and then they are removed at the clinic. At that stage, the nose is not how it's going to be long term. There may be a small amount of residual bruising which will continue to settle. In my opinion, it usually takes about two weeks for the patient to feel comfortable that they can return to work following this sort of surgery. It doesn't mean that the nose is normal in that stage because it will not be. The patients will be aware of persistent swelling, particularly on the bridge of the nose and around the tip for six to eight weeks after the operation. Then they will begin to feel more comfortable about how the nose looks.
 

When does the nose really feel like normal again after rhinoplasty?

For normal sensation, feeling and suppleness in the tissues and for all of the residual swelling and scarring to have settled, it will take a year. It should be emphasised that rhinoplasty is a real process. It's not just an operation that happens and then two weeks later you're fine. It is this evolution that occurs over up to a year before patients can feel that they have had their final result.