Nose Surgery & Nasal Repair FAQ

Plastic surgery covers a broad area of medicine, which includes both reconstructive procedures and cosmetic procedures. If your procedure is medically indicated, some portion (or all) of the cost may be covered. Our office accepts insurance in applicable cases and will, if you wish, contact your insurance company to find out if your procedure will be covered.

Swelling and bruising occur both on the outside and inside of the nose. It is normal to feel congested and have nasal obstruction and post-nasal drip immediately after nasal injuries. Most Washington, DC rhinoplasty patients and patients with a traumatic nose injury report that swelling resolves within a month. The final 20% of swelling takes a much longer time to resolve, up to a year or longer. Fortunately, this final swelling is usually only evident to Dr. Chaboki.

In addition to carefully following your surgeon’s guidelines, there are several things you can do to help reduce nasal swelling:

• Keep your head elevated
• Maintain the nasal splint / cast
• Apply ice to the cheeks, forehead, and nose
• Use Arnica Montana
• Avoid resting anything on the nose, including glasses and sunglasses
• Avoid blowing the nose or sneezing

Minor nasal injuries and fractures may not require surgical intervention. If your nose appears as it did before the injury, you may need no treatment other than rest and observation.

Broken bones of the nose normally require surgical intervention for repositioning and reshaping. Dr. Chaboki treats most broken noses in the office with local anesthesia. The procedure is very quick and simple and patients may return home afterward. He will place a cast over the nose made of tape and plastic. This nasal cast will then stay in place for a week.

For more severe injuries (or if the patient prefers), Dr. Chaboki will treat broken nasal bones in the operating room with general anesthesia or IV sedation (twilight anesthesia).

Dr. Chaboki will perform a comprehensive evaluation of the nose and face. You will be asked to explain how the injury occurred and how your nose looked before the injury (photographs taken before your injury may be helpful). He will ask about your general health and other medical problems. Dr. Chaboki will examine the external and internal nose, septum, cartilage, bone, and mucous membranes.

Usually an x-ray or computed tomography (CT) scan has already been performed prior to seeing Dr. Chaboki. Please bring all radiology images to the office, as Dr. Chaboki needs to see the actual pictures from the CT scan.

Depending upon the nature of the trauma and extent of the injury, an initial evaluation is normally performed at an emergency room. It is important to check for a septal hematoma (blood collecting around the nasal septum) and assess associated facial injuries. Septal hematomas are special emergencies, which must be treated promptly to prevent worse nasal problems from developing.

If you suspect a nasal fracture, you must be evaluated by a facial plastic surgeon within one week of the injury. Your broken nose may be repaired within one to two weeks from the day of injury. If you wait too long before plastic surgery evaluation, you will most likely need to wait several months before nose surgery in Washington, DC.

Patients with untreated broken noses have an undesirable appearance, as well as permanent difficulty in nasal breathing and congestion. Lastly, patients have associated cuts, bruises, lacerations, abrasions, and skin injuries which need plastic surgery evaluation to help prevent scarring and disfigurement.

Broken noses typically refer to fractures of the nasal bones; however, the cartilage of the nose and nasal septum may be injured as well. Nasal trauma usually occurs from sports, motor vehicle accidents, falls or fights. Sadly, nasal injuries may also be the result of domestic violence. Dr. Chaboki performs pro-bono work for FACE TO FACE: the National Domestic Violence project, and has frequently treated these types of injuries through his work there.

• A broken nose may result in a small crack of the bones without any change in appearance. However, a broken nose is usually obvious due to a variety of symptoms and signs, including:
• The nose appears to be deviated, crooked, or twisted.
• There is bruising and swelling both inside and outside of the nose.
• You may experience tenderness, especially at the bridge of the nose.
• Black eyes (dark bruises around the eyes) may be present.
• Skin appears to be swollen.
• There may be visible abrasions, lacerations, or cuts.
• There may be some nasal congestion.
• A nose bleed can also occur as a result of a broken nose.

Yes. Combining septoplasty with rhinoplasty near Maryland is beneficial for several reasons. First, by combining surgery, insurance may cover a portion of the procedure, and you may save money on fees. Secondly, cartilage modified from the nasal septum during the septoplasty may be used for grafts during the rhinoplasty. Dr. Chaboki may need to obtain cartilage from your ear or rib for grafts, if you have already had deviated septum surgery, since cartilage from the septum would not be available. Lastly, you will need only one recovery period following surgery, because you minimize downtime by avoiding two separate procedures.

Turbinate surgery is designed to reduce its size, primarily of enlarged inferior turbinates. Turbinoplasty is another name for surgery on the nasal turbinates. Turbinate surgery is usually combined with septoplasty, sinus surgery, or rhinoplasty. The inferior turbinate can be reduced in several ways:

• Directly cutting a portion off
• Removing the inside portion
• Pushing the turbinate outward
• Combination of the above

Surgery on the turbinates is done with specialized equipment and endoscopic cameras. All methods of turbinate surgery are performed entirely through the nostrils, without external incisions. Occasionally, turbinate tissue will re-grow or re-swell after turbinate surgery, and the procedure may need to be repeated. Dr. Chaboki has extensive experience in these various methods of turbinate surgery.

Some patients may have persistent nasal and sinus symptoms after deviated septum surgery. There are numerous reasons for this problem, including untreated allergies, regrowth or re-swelling turbinates, recurrent polyps, chronic infection, and trauma. Sometimes the nasal septum moves back, becoming crooked again, or insufficient cartilage and bone was removed from the initial procedure. Dr. Chaboki has specialized training in the anatomy, physiology, and cosmetic aspect of the nose. His expertise in both the internal and external nose will help treat your sinus nasal symptoms of allergy, nasal obstruction, snoring, nasal congestion, sinusitis, and post-nasal drip. He performs minimally invasive rhinoplasty, functional rhinoplasty, revision rhinoplasty, septoplasty, deviated septum surgery, turbinate reduction, and endoscopic sinus surgery.

Septoplasty is reconstructive plastic surgery performed to correct the nasal septum. Septoplasty is performed entirely through the nostrils, without external incisions. During the procedure, deviated portions of bone and cartilage may be removed entirely, or they may be readjusted and repositioned. The procedure has different techniques and approaches, largely dependent on the anatomy of the nasal septum for each particular person. Dr. Chaboki has extensive experience with all methods of deviated septum surgery, including the following:

• Submucous resection
• Swinging door / Goldman septoplasty
• Linear septoplasty
• Longitudinal septoplasty
• Fan septoplasty
• Endoscopic septoplasty
• Revision septoplasty

Deviated septum surgery may be combined with rhinoplasty, turbinate reduction, and/or endoscopic sinus surgery. For a majority of patients, septoplasty surgery does not alter the external shape of the nose, since the deviated portions of cartilage and bone are internal. Rhinoplasty (plastic surgery to reshape the nose), when performed along with a septoplasty, is often called functional rhinoplasty or septorhinoplasty. These methods of rhinoplasty are performed primarily to restore nasal function, such as breathing and airflow.

Various treatment options are available for patients with deviated septums. Recommended treatment will depend on the severity of symptoms, degree of septal deviation, prior treatments, and your medical history. Options include:

• Medication
• Nasal strips
• Alternative therapy
• Surgery
• Combination of the above

Medication is used when nasal symptoms are minor (intermittent stuffy nose, minor snoring). Initial treatment usually consists of antihistamines, nasal decongestants, and steroid containing nasal sprays. Nasal strips are small, bandage-like tapes have small plastic springs and are worn over the bridge of the nose. While the strips have no effect on the septum, they serve to spread the nostrils so that breathing through the nose is easier. While alternative therapies may not cure the problem, they do address the symptoms. Saline drops and sprays are very helpful in loosening mucus, removing pollen, and moisturizing the nose. A more effective treatment is nasal lavage, often done using a small pot with a spout. Saline solution is poured into one nostril and allowed to flow out the other nostril.

More than 150 million people suffer from allergies in the United States. Environmental allergens, such as pollen and mold, are especially worse in northern Virginia, Maryland, and downtown DC. Allergic symptoms are sometimes indistinguishable from a deviated septum. Patients may suffer from nasal congestion, snoring, post-nasal drip, runny nose, fatigue and tiredness, and facial pressure from either condition. Nasal allergies cause the mucous membranes of the nose and sinus cavity to swell up and create more mucous. A deviated septum is a structural condition of the nasal cartilage and bone. Both a deviated septum and allergies may occur at the same time. Only through complete testing can one differentiate the cause of symptoms for a particular patient.

Many patients think they may have an allergy to dust, pollen, mold, trees, or pets, but their nasal symptoms are primarily due to a deviated septum and/or large turbinates. Allergy patients may be treated with immunotherapy (allergy shots), in addition to antihistamines and allergy medication. These allergy shots are a series of injections that patients with allergies may choose in order to improve their health by reducing allergic symptoms and reducing the need for allergy medication. Allergy shots are specific for each particular patient, with injections performed in the office under medical supervision. While Dr. Chaboki, a facial plastic surgeon, does not treat allergies with shots directly, he works closely with many metropolitan Washington DC, northern Virginia, and Maryland allergists.

The sensation of nasal congestion may be due to a variety of conditions. A deviated septum is the most common cause of nasal obstruction. Enlarged turbinates is the second most common cause of breathing difficulty, and usually associated with a deviated septum. Other structural problems with the nose, such as small nostrils, weak nostrils, scarring, and a narrow or collapsed nasal valve, may also contribute to nasal obstruction. Many other conditions, such as medication side effects, allergies, irritants, chronic sinusitis, and systemic illnesses, can contribute to nasal breathing problems. The metropolitan Washington, DC area is especially problematic for people with allergies to pollen. These conditions can be treated with medicine and may not require surgery. As a rhinoplasty surgeon with extensive training in nasal surgery, Dr. Chaboki is able to identify and correct such problems. His comprehensive approach enables him to address all of the issues contributing to nasal obstruction.

Determining if a patient has a deviated septum is straightforward when diagnosed by a specialist such as Dr. Chaboki. After discussing your symptoms and medical history, he performs a physical exam of the external and internal nose, cartilage, bone, and mucous membranes. This exam involves a bright light and a nasal speculum (an instrument that gently spreads open your nostrils) and an endoscope (high resolution video camera) to inspect the inside surface of each nostril. An anesthetic nasal spray is used prior to the endoscopic exam to reduce the minimal pressure during examination. Additional testing may be required in some circumstances, such as a CT scan. CT imaging combines special x-ray equipment with sophisticated computers to produce multiple pictures of the internal nose.

The nasal septum is the foundation of the nose and contributes to its appearance. Deviated septums are very common. However, most patients are not aware of having a deviated septum, as their external nose is symmetric. A deviated septum may present itself on the external nose as a big or large nose, crooked or twisted nose, an over-projected nasal tip, a rounded nasal tip, or a hump.

Turbinates are normal structures in the nasal passages. There is an inferior, middle, and superior turbinate on each side of the nose. The turbinates are highly vascular tissue, consisting of bone, spongy erectile tissue, and mucous membrane outer lining. The turbinates, along with the septum and nose, humidify, warm, and clean the air we breathe. These structures also contribute to smell. The inferior turbinate is a largest turbinate, and the primary contributor to nasal and allergy symptoms. This turbinate, about the size of your finger, runs the length of the nasal airway. The inferior turbinate can change size dramatically. Temperature changes, lying down, infection, allergies, hormones, emotions, and dust all may increase the size of the turbinate.

Large turbinates, alternatively known as hypertrophied turbinates, contribute to nasal symptoms. In some patients, the nasal turbinate remains persistently enlarged and obstructs the airway, resulting in a congested feeling. Usually, when the underlying problem is treated, such as allergy or infection, the turbinate will shrink back to its normal size. However, in some people, the inferior turbinate will remain swollen and enlarged, even if the underlying problem is corrected. The most common symptom from large turbinates is nasal congestion, nasal obstruction, difficulty breathing through the nose, and snoring. The symptoms may be worse on one side, or alternate sides. Symptoms may appear during the day or may appear primarily at night. In some patients, the drainage of the sinuses is inhibited, resulting in repeated sinus infections or post-nasal drip.

The lower two-thirds of the nose is made of skin and cartilage, while the upper third is the nasal bones. One can consider the external nose, or what is visible, as the roof of a house. The nasal septum would then be considered both the cantilever and buttress of the nose to support the roof. The junction of the septum and nasal cartilage is called the “valve.” The valve is the narrowest portion of the nose, where a majority of nasal blockage occurs. A deviated septum and enlarged turbinates are the most common causes of narrowed valve, but blockage may also occur from scar tissue, weak cartilage, or collapsed nose. Patients who have narrow nostrils or nose or pinched noses typically have a narrow nasal valve.

Treatment is primarily surgery via cartilage grafts to help open the nasal passages and/or to help prevent collapse of the nose. Procedures on the nasal valve are sometimes called functional rhinoplasty or septorhinoplasty.

The nasal septum is a sheet of cartilage and bone that divides the nose into right and left chambers. A deviated septum is a condition where the septum is severely shifted away from the midline, bent, crooked or misshapen. Some degree of septal deviation is very common, as roughly 80 percent of all nasal septums are deviated.

The most common symptoms resulting from a deviated septum are nasal congestion, nasal obstruction, difficulty breathing through the nose, and snoring. Nasal congestion and breathing symptoms may be worse on one side or alternate sides. Symptoms may occur all day or primarily at night. In some patients, the drainage of the sinuses is inhibited, resulting in repeated sinus infections or post-nasal drip. A deviated septum may be present at birth, caused by an injury, or result from damage from previous treatments or surgery.

Dr. Chaboki provides the finest in both cosmetic and reconstructive plastic surgery at affordable prices, and participates with most insurance plans. Plastic surgery covers a broad area of medicine, which includes both reconstructive procedures and cosmetic procedures. If your procedure is medically indicated, some portion of the cost may be covered. The office accepts insurance in applicable cases and will, if you wish, contact your insurance company to find out if your procedure will be covered. Insurance coverage varies greatly for patients; however, Nose Surgery & Nasal Repair may be partially or fully covered.

Generally, a minimum of 2 weeks are allowed from the consultation to prepare for surgery. Select procedures may be performed earlier. Nonsurgical procedures may be performed at the same time as the initial consultation.

Yes, it’s generally preferred to combine procedures. First, by combining surgery, insurance may cover a portion of the procedure, and you may save money on fees. Secondly, tissue modified from one area may be used for another surgical area, such as fat transfer and face lifting. Lastly, you only need one recovery period following surgery, which means you minimize downtime by avoiding two separate procedures. Commonly combined procedures with nose surgery & nasal repair include the following:

• Rhinoplasty
• Facial Sculpting
• BOTOX® Cosmetic

Strenuous activities or exercise after plastic surgery will increase the risk of bleeding, swelling, and bruising, until an appropriate healing time has been allowed. This restriction during the recovery period varies, based on the operation performed and patient’s medical condition. Light activities, such as slow walking, may be performed soon after anesthesia. Heavy activity, such as aerobics, yoga, cycling, running, heavy lifting, or similar vigorous activities are allowed 2 weeks after the procedure. Contact sports are generally allowed 6 weeks after surgery.

Most patients plan at least a few days off from work. A longer period of recovery may be necessary for combined procedures.

Nose Surgery & Nasal Repair is a relatively quick surgical procedure. The length of surgery may range from 30 minutes or longer.

Dr. Chaboki performs a complete history and physical on all patients prior to undergoing nasal treatments. Washington, DC rhinoplasty and nasal repair may usually be safely performed on many chronic, stable medical conditions. However, nose surgery and nasal repair may be delayed or cancelled as needed for patient safety. Dr. Chaboki works with his patients to help find a safe, appropriate plastic surgery option for them.

Smoking adversely affects your recovery. One may develop pneumonia, and treated areas don’t heal as well or may become infected. The blood vessels that supply oxygen and nutrients to the tissues shrink and prevent the necessary healing of the area. Patients must stop smoking for a minimum of two weeks prior to surgery to decrease the risk of these complications, and continue smoking cessation after the procedure.

Downtime after nasal procedures may be a few hours to several days, depending on the specific procedure and areas treated. Office procedures are performed under local anesthesia, if any anesthesia is required. Surgical procedures are performed with either IV (twilight) sedation or general anesthesia and require a longer recovery period. Anesthesia normally wears off within the first 24 hours after surgery.

Septoplasty is an outpatient procedure, with most people returning to work within a few days. A small cotton pad may be placed in the nose for a day. Patients are seen both the next day and one week following surgery. While most patients may have improved breathing immediately, normal swelling inside the nose after the procedure takes some time to resolve. A majority of patients do not have the shape of their noses changed with surgery. However, septoplasty performed as part of functional rhinoplasty or septorhinoplasty will change your appearance. Dr. Chaboki will inform you of expected outcomes for your procedure.

Dr. Chaboki practices facial plastic surgery at several DC area surgical facilities to accommodate his patients. Minor procedures with local anesthesia are performed in the DC office. Surgical procedures with IV (twilight) sedation or general anesthesia are performed at accredited facilities with a board-certified anesthesiologist:

• Georgetown University Medical Center
• MedStar Surgery Center