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Sinus Surgery FAQ

Dr. Houtan Chaboki is board-certified in head and neck surgery (otolaryngology) and facial plastic and reconstructive surgery. To learn more about Washington, DC sinus treatment surgery, contact us online or call our office at (202) 800-2085. Dr. Chaboki serves men and women in Washington, DC, Northern Virginia, and Maryland.

1. Where is Sinus Surgery performed?

To accommodate his patients, Dr. Chaboki performs facial plastic surgery at several DC area surgical facilities. He performs minor procedures with local anesthesia 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
  • Sibley Memorial Hospital
  • The George Washington University Medical Center
  • MedStar Surgery Center

2. What is recovery like after Sinus Surgery?

Depending on the specific procedure and areas treated, downtime after nasal procedures may be a few hours to several days. 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.

Sinus surgery is an outpatient procedure, with most people returning to work within a few days. Dr Chaboki may place a small cotton pad in the nose for a day. He sees patients both the next day and one week after surgery. While most patients may breathe better immediately, normal swelling inside the nose after the procedure takes some time to resolve.

3. Will smoking affect my recovery after Sinus Surgery?

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

4. What health conditions threaten a successful recovery after Sinus Surgery?

Washington, DC sinus treatment surgery may usually be safely performed on patients with various chronic, stable medical conditions. However, sinus surgery may be delayed or cancelled as needed for patient safety. Dr. Chaboki performs a complete physical and discusses the patient's history prior to undergoing reconstructive treatments. Dr. Chaboki works with his patients to help find a safe, appropriate plastic surgery option for them.

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5. How long is the procedure?

Sinus surgery is a relatively quick surgical operation. The length of surgery may take 30 minutes or longer.

6. Will I need time off work after Sinus Surgery?

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

7. When can I resume regular exercise after Sinus Surgery?

Before your body heals, strenuous activity or exercise after plastic surgery will increase the risk of bleeding, swelling, and bruising. How long patients should restrict their activity during recovery varies, based on the operation performed and patient's medical condition. Light activities, such as slow walking, may be performed soon after anesthesia. Heavier activity, such as yoga, aerobics, cycling, running, and heavy lifting, is allowed two weeks after the procedure. Contact sports are generally allowed six weeks after surgery.

8. Can I combine Sinus Surgery with other facial surgery?

Yes, it's generally preferred to combine procedures. By combining surgery, you may save money on fees because insurance may cover a portion of the procedure. Additionally, tissue modified from one area may be used for another surgical area, such as fat transfer and face lifting. Lastly, you only have one recovery period following surgery instead of two, because you minimize downtime by avoiding two separate procedures. Commonly combined procedures with sinus surgery may include rhinoplasty and facial sculpting.

9. How much time passes between the initial consultation and Sinus Surgery?

Typically, a minimum of two weeks should pass between the consultation and your surgery. However, some procedures can be performed earlier, such as nonsurgical procedures, which may be performed at the same time as the initial consultation.

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10. Does insurance cover Sinus Surgery?

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

11. What is a Deviated Septum?

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

The most common symptoms caused by a deviated septum are nasal congestion, nasal obstruction, difficulty breathing through the nose, and snoring. Nasal congestion and breathing symptoms may occur all day or primarily at night and may be worse on one side, or alternate sides. In some patients, sinuses drainage is inhibited, causing 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.

12. What are the Nasal Turbinates?

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.

Lying down, temperature changes, infection, allergies, emotions, hormones, and dust all may increase the size of the turbinate. Large turbinates, also known as hypertrophied turbinates, contribute to nasal symptoms. In some patients, the nasal turbinate remains persistently enlarged, obstructs the airway, and causes a congested feeling. The turbinate will usually shrink back to its normal size when the underlying problem is treated, such as allergy or infection.

However, sometimes the inferior turbinate will remain enlarged and swollen, even if the underlying problem is corrected. The most common symptoms from large turbinates are nasal congestion, nasal obstruction, difficulty breathing through the nose, and snoring. The symptoms may be worse on one side, or alternate sides. Symptoms may persist all day or primarily at night. Sinus drainage is inhibited in some patients, resulting in repeated sinus infections or post-nasal drip.

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13. What are the Sinuses?

The nasal sinuses are air spaces lined with a mucous membrane and surrounded by bone. The nasal sinuses drain through small passageways into the nasal cavity. Although patients normally do not notice it, some patients with severe allergies may feel this sinus drainage as post-nasal drip. Also called the paranasal sinuses, they are believed to help humidify, clean, and moisten the air we breathe. There are four main sinuses that come in pairs: maxillary, frontal, ethmoid, and sphenoid. The nasal sinuses are in a relatively small area and are very close to the brain, eyes, and teeth.

Chronic sinusitis may contribute to the following symptoms:

  • Sinus headaches
  • Facial pain or pressure
  • Nasal congestion
  • Post-nasal drip and drainage
  • Decreased breathing through the nose
  • Recurrent infections
  • Decreased or altered sense of smell

Functional endoscopic sinus surgery (FESS) opens the natural drainage passages of the sinuses for appropriate patients and may help alleviate sinus symptoms. FESS is an outpatient procedure that is generally performed with a small camera via the nostrils.

14. Does a Deviated Septum affect the appearance of the nose?

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

15. How is a Deviated Septum diagnosed?

After discussing your symptoms and medical history, Dr. Chaboki 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. In some circumstances, additional testing, such as a CT scan, may be required. CT imaging combines special x-ray equipment with sophisticated computers to produce multiple pictures of the internal nose.

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16. What causes Nasal Obstruction and Difficulty Breathing?

A variety of conditions can cause nasal congestion. A deviated septum is the most common cause of nasal obstruction. Enlarged turbinates is the second most common cause, which is 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 allergies, irritants, chronic sinusitis, medication side effects, and systemic illnesses, can contribute to nasal breathing problems. These conditions can be treated with medicine and may not require surgery.

17. What is the difference between Allergies and Deviated Septum?

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. Both conditions can cause post-nasal drip, runny nose, nasal congestion, snoring, fatigue and tiredness, and facial pressure. Both a deviated septum and allergies may occur at the same time.

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. Only through complete testing can the cause of symptoms for a particular patient be determined.

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 personally perform allergy injections, he works closely with many metropolitan Washington DC, Northern Virginia, and Maryland allergists.

18. What are the treatment options for a Deviated Septum?

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

  • 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. The strips have no effect on the septum and 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 loosen mucus, remove pollen, and moisturize the nose. A more effective treatment is nasal lavage, often done using a small pot with a spout. Nasal lavage works by pouring saline solution into one nostril and allowed to flow out the other nostril.

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19. What is Septoplasty and how does it correct a Deviated Septum?

Septoplasty is reconstructive plastic surgery performed to correct the nasal septum. It is performed entirely through the nostrils. During the procedure, deviated portions of bone and cartilage may be readjusted and repositioned or may be removed entirely. Depending on the anatomy of the nasal septum for each person, the procedure can use several different techniques and approaches. 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.

20. What is Revision Septoplasty?

Some patients may have persistent nasal and sinus symptoms after deviated septum surgery. There are numerous reasons for this problem, including untreated allergies, re-growth or re-swelling turbinates, recurrent polyps, chronic infection, and trauma. Sometimes the nasal septum shifts and becomes crooked, or insufficient cartilage and bone were removed from the initial procedure. Dr. Chaboki has specialized training in the anatomy, physiology, and cosmetic aspect of the nose and 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. Additionally, he performs minimally-invasive rhinoplasty, functional rhinoplasty, revision rhinoplasty, septoplasty, deviated septum surgery, turbinate reduction, and endoscopic sinus surgery.

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21. How are large turbinates reduced with Turbinate Surgery?

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
  • Pushing the turbinate outward
  • Removing the inside portion
  • Combination of the above

All methods of turbinate surgery are performed without external incisions through the nostrils and are done with specialized equipment and endoscopic cameras. 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 with these various methods of turbinate surgery.

22. What is Endoscopic Sinus Surgery?

The nasal sinuses are air spaces surrounded by bone and lined with a mucous membrane. The sinuses create mucous which drains through small passages into the nasal cavity. Endoscopic sinus surgery is a minimally invasive procedure, where a small camera is placed in the nose to open the sinuses by making these small drainage pathways larger and wider. Dr. Chaboki removes polyps, thick mucus, and chronic infection. Endoscopic sinus surgery may involve only one sinus chamber or more. It may also be combined with septoplasty, turbinate reduction, or other nasal surgery. By opening the natural drainage passages, endoscopic sinus surgery may help alleviate sinus symptoms in appropriate patients.

23. Can Septoplasty or Functional Nasal Surgery be combined with Cosmetic Rhinoplasty?

Yes. Combining septoplasty with rhinoplasty is beneficial because by combining surgery procedures, insurance may cover a portion of the procedure, and you may save money on fees. Additionally, cartilage modified from the nasal septum during the septoplasty may be used for grafts during rhinoplasty surgery. 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, the recovery process following surgery would only be once, and you minimize downtime by avoiding two separate procedures.

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    Houtan Chaboki, M.D.