Category Archives: Septoplasty

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submucous resection and septoplasty

Seven differences between submucous resection and septoplasty

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Submucous resection and septoplasty are simple but highly technical rhinoplasty procedures aiming to correct the deviated septum. A deviated septum is a widespread problem; many people can go through their life without it being a bother. However, some do feel severe symptoms of the deviated or crooked septum and both functional and cosmetic aspects necessitating surgical intervention by an expert rhinology surgeon.

What is the nasal septum?

The septum is a vital cartilage piece that ideally should divide the insides of the nose into two equal compartments. However, when bent, it can cause crookedness in the nose and other problems.

You may not even know you have a deviated septum; however, a few septal can be problematic when they cause any of the following symptoms.

  • Obstruction in the nostrils (one or both): When the septum blocks a nostril, it can make it difficult to do normal breathing. This blockage becomes more pronounced when you suffer from a cold or a nasal allergy because the nasal passages swell and narrow.
  • Nose bleeds: because of the crookedness, the nasal septum can become dry and increase nosebleeds.
  • Pain in the face: This symptom is usually observed in cases of deviation. The surfaces within the nose touch cause pressure to one side of the face, leading to pain.
  • Snoring and noisy breathing when sleeping: Deviated septum in your nose causes the airways not able to pass the air properly, and it causes loud and bothersome breathing during sleep.
  • Alertness towards the nasal cycle: the natural nasal process compromises obstruction on one side and then to the other. Because of nasal obstruction, people with a deviated septum are often aware of this cycle.
  • Preferring sleeping on one side: People with narrow nasal passages tend to sleep on one side to optimize breathing through the nose and make sleeping and everyday work more comfortable.
  • Nasal congestion: Sometimes, it feels like there is always something inside the nose, and it feels uncomfortable. This can also cause the problem of sleep apnea, in which the breathing automatically starts or stops.
  • Sinusitis: Inflammatory changes in the nasal canal and the sinus tissues make it difficult for nostrils to drain correctly; hence, the fluid accumulates in the sinus cavity, leading to chronic pain and pressure, leading to sinusitis.

The deviated septum can be caused because of many things, such as congenital disabilities, injury, or trauma to the nose because of rough play or contact sports. In adults, the most common cause of a deviated septum is a direct injury to the nose. The deviated septum can worsen as we age, leading to more issues. The two most common nose surgeries done to alleviate the deviated septum symptoms are septoplasty and submucosal resection. The selection of the surgery depends on the type of deviation. Septum deviation is classified into five types.

Surgical management of deviated septum is a challenging surgery that needs the best rhinologic surgeons who are experts in aesthetics and functional failures caused before and post-surgery. In the last few years, the surgery for deviated septum has seen many modifications to preserve the septal framework. The diagnosis for both submucous resection and septoplasty needs a detailed analysis of the nasal skeleton and its shape with the rest of the facial structure.

Both surgeries aim to correct the septum inside the nose to promote better breathing and make the nose straighter. This makes both work and personal life better for the patients. However, they differ in various aspects, such as

  • Surgical technique: The septoplasty aims to straighten the deviated septum, and the resection technique removes the extra tissues (enlarged nose’s inferior turbinates) from the septum to open up the airways. SMR (submucous resection) removes the deviated septum or decreases the sign of external deviation. In SMR, the surgeon accesses the septum by elevating the flaps on both sides, but in Septorhinoplasty, the flaps are lifted from the concave side of the nose.
  • Type of surgery: SMR is a radial surgery with a large amount of tissue excavation and removal, whereas septoplasty is a conservative surgery with minimum tissue removal.
  • Endonasal or external: Submucous resection to correct the nasal deviation is performed through an open rhinoplasty, and septoplasty or the Septorhinoplasty can be done through open nose surgery.
  • Age of surgery: SMR can only be done on children above 17 when the bones and cartilage have stopped growing, whereas septoplasty can be done on children also to give them immediate relief.
  • Cartilage: The septoplasty aims to preserve as much nose cartilage as possible, but in SMR, the nose loses most of this cartilage.
  • Revision rhinoplasties: Since the submucous resection removes most of the nasal cartilage, it is difficult to perform another surgery after this type of deviation correction, however in cases of Septorhinoplasty, the rhinoplasty surgeon can do another surgery
  • Changes to the external structure of the nose: SMR does not change the nose’s appearance, but Septorhinoplasty can give you a straighter-looking nose.

Submucous resection for correcting deviated septum procedure

The SMR is a highly successful procedure that reduces the size of the inferior turbinate in the nose. The primary function of turbinates is to keep the air we breathe humidified and warm and make breathing easier. Each side of the nose has tree turbinates. When the turbinate near the bottom of the nose enlarges, it can cause breathing difficulties. Also, when the deviated septum cannot be treated in other ways and is causing disruptions in the patient’s everyday life, then SMR becomes the suitable option for a long time and immediate relief. Here are some essential things to know about submucous resection surgery of nasal septum

  • It is a one-day procedure; in most cases, there is no need to stay in the hospital overnight.
  • The surgeon will use local or general anesthesia, and the surgery takes only about 1.5 hours to complete
  • The surgeon makes small incisions in the nose and then slices up the extra tissue. This operation does not disrupt the mucus lining.
  • Then the surgeon will close the incisions, and you are on your way to recovery. There is no visible external scar on the outside of the nose.

When does a rhinoplasty surgeon recommend submucosal resection?

SMR is not a necessary surgery for a deviated septum, but a nose surgeon will recommend an SMR if you want relief from

  • Chronic sinus infections that have not responded to traditional treatments
  • Nose bleeds because of septal deviation
  • Difficulty in breathing because of a crooked septum

This surgery can also be combined with routine sinus surgery to give the surgeon better access to other parts of the nose. SMR is also done as a part of cleft palate repair.

Cost of septoplasty and submucous resection of the nasal septum

Since both surgeries do different corrections, their price is different than each other too. the cost of SMR and septoplasty is dependent on

  • Surgeon’s expertise and experience
  • Location of the clinic
  • Any further corrections are done alongside it if necessary.
  • Anesthesia and hospitalization fees

When the procedure is done for functional reasons, it is generally covered by insurance; therefore, you should talk to your insurance provider and check.

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Saddle Nose

How to know if I have a Saddle Nose?

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The saddle nose, pug nose, or boxer nose is a type of nose deformity characterized by a distinct dip or sag in the middle portion of the nose. This ‘saddle’ can be barely noticeable or severe enough to cause breathing problems. However, the saddle nose is clearly visible in the side profile photos and selfies, and people often feel very conscious about it. In severe cases of saddle noses, there can be obvious nasal deformities that alter the shape and function of the nose. Most patients can go through their life with a saddle nose, but corrections become necessary for some.

Saddle nose has cosmetic repercussions too. It can make your entire face look flat. You can quickly identify saddle nose with the following symptoms:

  • The collapse of the nasal bridge cartilage
  • Upward rotation of the nasal tip
  • Obstructions in breathing through one or both nostrils
  • Nasal crusting which becomes chronic
  • A visible horizontal crease in the lower part of the nose that looks like a dent in the nose.
  • Septal perforation
  • Nose bleeds
  • Whistling sound during nasal flow

It is common for people with saddle noses to feel conscious about the dip in the nose, especially during picture-taking times. The excellent news is saddle nose deformity can be easily corrected. However, this repair is a highly specialized procedure as this surgery is different for every patient depending on the indicators and desired alterations.

What causes saddle nose?

The most visible indication of saddle nose is the loss of dorsal height or a noticeable degree of nasal dorsal depression. There can be many reasons for this loss of height. The septum is of the critical parts of the nose and a central one too. It is responsible for the structural integrity of the nose. Any damage to the septum structure causes a sunken appearance of the nose. This causes many cartilage and bone defects. This deformity mainly originates because of

  • Congenital reasons such as Cleidocranial dysostosis, which affect the teeth and bone, and Congenital syphilis, which is an infection passed from the mother to the child
  • Trauma: Direct trauma to the nose can cause the bones to break or damage the cartilage structure. Depression in the nasal bone can also cause saddling or sagging and loss of height.
  • Surgical causes: A prior rhinoplasty, a Septorhinoplasty, or changes in the septal cartilage that are not done correctly or not appropriately healed can also cause nasal deformities such as the saddle nose. Septorhinoplasty in young patients can also cause a collapse of the nasal septum because the septum is weak and collapses as they grow. Removing too much septal cartilage is another reason for saddling.
  • Over reduction of the dorsal hump: Surgical removal of the camel-shaped shape on the nasal bridge can also cause depression in the middle of the nose.
  • Poorly done rhinoplasty to correct nasal contours, which causes over the projected nasal tip, or a supra tip correction, can make the nose appear saddled.
  • Down syndrome
  • Normal variation
  • Infections
  • Illness caused by medical treatment
  • Medical causes such as leprosy, syphilis, recurring infections in the tissues, Wegener’s Granulomatosis, and Relapsing Polychondritis. Syphilis can also cause severe cartilage damage.
  • Accidents
  • Septal hematoma and septal abscess, which cause the normal blood flow to the septum to be obstructed, can also cause a saddle nose deformity.
  • Cocaine abuse: Long-standing use of cocaine leads to a deficit in blood flow in the septum, which causes it to become weak and eventually collapse. The chronic use of intranasal decongestant sprays also causes this safe effect.

Saddle nose rhinoplasty includes both camouflage and reconstruction treatments. In most cases, saddle nose deformity is acquired, and its manifestation depends on individual, racial, or genetic characteristics. Trauma and iatrogenic causes are the two most common causes of saddling.

Types of saddle noses

Treating or correcting saddle nose deformity begins with correctly categorizing its severity. This classification is based on the anatomic issues causing saddle nose and include

  • Type 1 has dorsal nasal depression, but the lower third of the nose has normal tip projection.
  • Type 2 which has moderate to severe depression with a prominent lower third of the nose upturn
  • Type 3 with moderate to severe dorsal depression and loss of tip support, and visible structural deficits
  • Type 4 with severe normal depression and loss of structural support to the entire nose.

Type 2,3 and 4 deformities cause difficulties in breathing too.

Saddle nose rhinoplasty

Depending on the manifestation of the saddling and the investigation into the exact nature of deformity and dysfunction help the surgeon select the best reconstructive options to correct the deformity: these address both the aesthetic and functional aspects.


This is done by taking in the patient’s complete history and doing a physical examination. This helps the surgeon figure out the etiology of the deformity. The doctor will also ask about any history of nasal airway obstructions, past nasal traumas, nasal surgeries, history of autoimmune diseases, etc. if the patient has been using cocaine, then it needs to be investigated too.

The physical examination includes the degree of the location of the saddle, the condition of the nasal septum, the state of nasal valves, and the structural stability of the nasal support structures. Both imaging and diagnostic tools are used for this.


There are two parts to the treatment. One is medical, which is aimed at containing the progression of saddling. Patients suffering from diseases such as Wegener granulomatosis and relapsing polychondritis need the intervention of medical specialists to help improve the condition.

The second part is surgical rhinoplasty or nose job that corrects the saddle nose defects. This nose surgery is done to add or restore strength to the cartilage at the base of the nose. Saddle nose rhinoplasty is one of the most complicated nose surgeries because it requires a carefully crafted graft to be placed in the nose and planning of anatomical reconstruction of the other structures.

In case of mild saddling, getting a proper graft from the septum or conchal cartilage might be possible. However, in case of greater severity of the deformity, the surgeon will recommend taking cartilage from the ribs or using artificial cartilage. In grafts obtained from external sources, the following criteria should be met.

  • They should be noncarcinogenic.
  • Nonallergenic
  • Nonimmunogenic
  • Non-destructive to the adjacent tissue and be bio integrable
  • Non-resorbable for durability
  • Easy to mold, remove and work with
  • Should feel similar to the actual cartilage and have the same strength
  • It should be readily available
  • Cost-effective
  • Zero extrusion rate.

The suitability of the graft will depend on the degree of saddling. The choice of material and type of reconstruction plays an important role and saddle nose deformity correction. There is no one ideal nasal implant. Each implant has its only successes and failures; your doctor will be the best one to decide which will suit your problem.

Rhinoplasty for saddle nose corrections takes about 2-3 hours to complete. The grafts are carefully shaped and sterilized first. Then the surgeon will make an incision along the columella of the nose and lift the skin. Finally, the graft is placed, and other structural corrections are done per the treatment plan.

Who can get saddle nose surgery?

A healthy patient bothered by the saddle nose opts for this rhinoplasty surgery. However, some persons with contraindications include

  • Patients with autoimmune conditions in whom the damage can be continuous
  • Intranasal drug abusers who have failed sobriety
  • Unhealthy patients and those with a poor risk profile, such as schizophrenia patients.
  • Patients who have unrealistic expectations

This rhinoplasty is also not recommended for people who

  • I have had some previous rhinoplasties
  • Have a history of smoking
  • Are 16 years or younger
  • Patients who are likely to experience nasal trauma such as boxers, martial artists, etc.

Saddle nose surgery recovery

Mild swelling and bruising are expected after the surgery but will decrease in 10 odd days. You should take great care of your nose and avoid blowing or sneezing through it. Don’t try to touch the nose too often or pull or tug at it. The full results appear as the skin heals, and you can see complete healing in one year of surgery.

Saddle nose surgery cost

Saddle nose surgery is one of the most challenging nose deformities to correct for the surgeon. The correct surgical approach is essential, which can have a physiological impact on the patient. The cost of saddle nose surgery in India depends on the graft type used and the surgical approach used.

Other factors that influence the price of this type of rhinoplasty are the surgeon’s expertise, the hospital cost price, the location of the clinic, and the post-operative consultations. Since it is mainly done for functional reasons, the cost of saddle nose rhinoplasty is usually covered by insurance.

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Know the Difference Between Rhinoplasty and Septoplasty?

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Know the Difference Between Rhinoplasty and Septoplasty?

A nose job is a very popular type of surgery and it covers a vast number of procedures under its umbrella. This is not surprising because the nose is located at the front and centre of the face and it has a very important role in maintaining regular functions. The main function of the nose is to control and filter the airflow and help you breathe properly. But there is another important role of the nose is the beauty of the face. A crooked nose can make your lips look crooked. The crooked nose can be because of a slanted tip or it might be because of the deviated septum or bone structure.  The balance and harmony that the nose brings to the face are unique.

There are two main types of nose surgery:

septoplasty and rhinoplasty. both aim to improve the nose but address different issues. They can be done as stand-alone surgeries or combined for better results.

Many times what we see as a deformity on the nose from the outside is actually related to some internal issues as well and both need to be treated to make the patient comfortable. Rhinoplasty focuses on treating the external appearance of the nose and septoplasty is aimed to correct or improve the internal defects.

When you visit the surgeon for a nose job, he will ask you about your concerns in detail and then help choose the right treatment for you. Rhinoplasty and septoplasty both have different goals but the aim is to improve your quality of life and self-confidence. It is therefore important to understand the difference between septoplasty and rhinoplasty to know what difference it will make in your nose and facial profile. Here we have listed some common things and major differences between rhinoplasty and septoplasty to help you understand which one to choose.


A rhinoplasty nose job is mostly done for cosmetic reasons primarily. The nose is a complex organ and each person’s nose is very unique. Therefore, the ideal nose for each person is different and there is no mould that every nose can fit in. therefore your nasal structure has an individual relationship with your facial features. Unlike other plastic surgery procedures, conservatism is a prime consideration in rhinoplasty to preserve the natural and soft look. It is important to let your doctor know about what you are looking to correct.

Rhinoplasty can be done to

  • Reduce the size of the nose
  • Change the width of the bridge
  • Correct the hump on the bridge
  • Lengthen the nose
  • Make your nose symmetrical
  • Straighten a crooked nose
  • Change the orientation of the nose tip and alter its size and shape
  • Remove the depression on the bridge
  • Correct the size, position, and shape of the nostrils

Every patient has a different set of preferences when it comes to selecting the type of rhinoplasty. the final aim is to achieve a natura look that fits well with your facial features. There are very high degrees of refinement that can be achieved with surgical nose reshaping. In a rhinoplasty nose job, a detailed consultation is done with the surgeon about what you like and don’t like about your nose. the surgeon will carefully asses your nose, look at the photos, examine your skin type, and work with you to work out what nose shape works for the structure of your face. This procedure can be done in a minimally invasive way too i.e., with the use of threads or fillers. This is called liquid rhinoplasty and is done to augment the nose. A Liquid nose job is a temporary procedure less costly than the traditional rhinoplasty. Rhinoplasty can be done under local or general anaesthesia. Rhinoplasty is usually not covered by insurance.


This type of nose job is done to correct the shape of the septum. The septum is the thin wall that separates the two nostrils. The septum has important functions, it supports the nose and helps direct the airflow. It is composed of cartilage and thin bone. When either the cartilage or the bone is not straight, it is called a deviated septum.  This can happen because of birth or an injury. About 80% of people around the world have some degree of deviation in the septum.

Deviated septum sometimes does not cause any symptoms or problems in an individual. But when left untreated or if it gets severe it can cause many problems such as

  • Reducing the airflow and causing difficulty in breathing. This obstruction can get worse when you get some cold or allergies as it can cause the nasal passage to become narrow and swell.
  • Deviated septum can cause dryness in the effect of airflow and it can cause crusting or bleeding in some people.
  • A crooked septum can also cause congestion in the nose and cause swelling in the tissue and skin lining on the insides of the nose. Medications can help reduce the swelling but not solve the deviated septum problem.
  • Snoring or noisy breathing when sleeping because of deviated septum and swelling in the tissues of the nose and obstructed breathing.
  • Sinus infections are mainly caused because of deviated septum and it can disrupt the person’s entire life. A chronic sinus infection can cause swelling, irritation and inflammation in the nasal passages.
  • Obstructive Sleep apnea is a condition caused by deviated septum and it results in a person to stop breathing in the night during the sleep. This can happen multiple times during the night. Sleep apnea decreases the oxygen supply to the brain and other parts of body.

People suffering from deviated septum tend to sleep on one side to adjust breathing through the nose. Deviated septum should be treated to avoid long term and short-term health problems. Septoplasty to correct the deviated septum is a simple surgery that can help relieve the patient of long term pain and  discomfort. Deviated septum cannot be treated with medications.

When untreated conditions like sleep apena can cause blood pressure, heat attack, diabetes, depression, headache, ADHD, stroke and even cause poor performance in daily life and even affect the children.


If you have difficulty in breathing or have had a recent trauma to the nose that has changed your breathing pattern then it is time to talk to your surgeon about septoplasty. The surgeon makes an incision to divide the nasal mucosa from bone and cartilage. Then the cartilage is straightened. Also if the problem is the bone then then the surgeon will have to trim the bone or add a graft to help correct the deviation. Spreader grafts are small reinforcing strips that correct the deviated septum that is causing the problem along the bridge of the nose. Then the mucosa back over the bone and cartilage and the nose shape returned to normal. Septoplasty is a medical treatment is covered by insurance.

When Septoplasty and Rhinoplasty overlap

Sometimes the deviated septum can cause off balance in the facial appearance too and hence septoplasty can be combined with rhinoplasty and it is called Septorhinoplasty. This not only corrects the breathing problem but also improve facial aesthetics. Every nose job needs to consider function and appearance. Septoplasty is careful about not disrupting the aesthetics of the nose and rhinoplasty is done carefully to preserve the nasal passageways. Deviated septum and rhinoplasty are commonly preformed surgeries which are very safe and effective.

You can get a rhinoplasty and septoplasty at the same time and it has a lot of benefits in terms of

  • Cost
  • Safely
  • Recovery
  • Convenience

Cost of septoplasty and rhinoplasty

Septorhinoplasty is done in one go but the cost of septoplasty and rhinoplasty with insurance is different. Because the functional rhinoplasty is covered by insurance and rhinoplasty is not therefore you must talk to your provider before confirming for the surgery. when done together septoplasty and rhinoplasty cost is very economical i.e., Cost effective one because

  • The anaesthesiologist fees comes onto play only once.
  • You need to pay the surgeon’s feel only once
  • Better results without need of revision rhinoplasty
  • Fewer consultation.

About Dr. Debraj Shome

Dr. Debraj Shome- Facial Plastic Surgeon in Mumbai, India

Dr. Debraj Shome – Founder, The Esthetic Clinics, is a top facial plastic surgeon. Dr. Shome is currently a Consultant at the best Mumbai hospitals like Saifee Hospital, Breach Candy Hospital, Nanavati Hospital & Apollo Spectra Hospital in Mumbai, India. He has 40+ research papers in the best international journals, numerous presentations at conferences & many awards such as “Best Plastic Surgeon in Mumbai”, “Best Plastic Surgeon in India”, Best Cosmetic Surgeon in India”, “Best Cosmetic Surgeon in Mumbai”, “Breakthrough Innovator in Facial Plastic Surgery” etc. A celebrity plastic surgeon, Dr. Shome believes plastic, reconstructive & cosmetic face surgery can allow you to lead a more fulfilled life….Read more

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