Plastic Surgery Guide for Nasal Septal Cartilage Free Grafting in New York City!

Introduction

In New York City, the realm of plastic surgery offers advanced solutions for nasal concerns, with nasal septal cartilage free grafting being a prominent technique. This guide will delve into various aspects related to nasal surgeries involving cartilage grafting, including septoplasty, spreader grafts, and saddle nose repair. These procedures not only enhance the aesthetic appearance of the nose but also improve its functionality, such as breathing. Whether it's correcting a deviated septum, addressing nasal valve issues, or reconstructing a damaged nose, understanding the details of these surgeries is crucial for those considering plastic surgery in NYC.

Septoplasty: Correcting Deviated Septum

What is Septoplasty?

Septoplasty is a surgical procedure aimed at correcting a deviated nasal septum. The nasal septum is the wall that divides the two sides of the inner nose. In a healthy nose, it should be properly aligned in the center. However, for some people, the septum can be crooked, a condition known as a deviated septum. This deviation can block the nasal passage and lead to symptoms such as nasal blockage, breathing difficulties, snoring, sinusitis, and sleep apnea.

Dr. Philip Miller, a septoplasty specialist in NYC with over 20 years of experience, performs septoplasty to realign the septum into the midline. During the procedure, an incision is made within the nostrils, and the lining over the septum (the mucosa) is gently separated from the septum. This exposes the deviated pieces of cartilage and bone, which are then repositioned or reshaped. Once completed, small plastic supports may be inserted into the nose to help the septum stay stable for the first week following surgery. The procedure usually takes between 60 to 90 minutes and is done on an outpatient basis, allowing patients to return home the same day.

Candidates for Septoplasty

• Individuals who experience excessive snoring, sleep apnea, recurrent sinusitis, or other respiratory complaints may be good candidates for septoplasty. An otolaryngologist (ear, nose, and throat doctor), like Dr. Miller, can examine the patient to identify whether a deviated septum is the cause of these problems.
• Patients who have a deviated septum as a result of injury or trauma to the nose may also be candidates. In some instances, a nose job procedure may need to be performed in addition to the septoplasty to correct the external appearance of the nose as well as the deviated septum.
• Septoplasty is also suitable for those with recurrent rhinitis or other chronic sinusitis. It can also be done to alleviate recurrent epistaxis (nosebleeds) due to septal impaction or septal spur. Additionally, it can be performed for cosmetic purposes to straighten a crooked or deviated nose. However, it should not be performed on patients presenting with acute sinus or nasal infection, nor on individuals with untreated diabetes, bleeding diathesis, or severe hypertension.

Benefits of Septoplasty

Risks and Recovery of Septoplasty

While septoplasty is a common surgical procedure with a very low risk of complications when performed by a board - certified plastic surgeon, some rare complications can occur. These include bleeding, septal hematoma, septal perforation, and hyposmia (decreased sense of smell). During the recovery period, patients can expect mild to moderate tenderness or pain at the front of the nose, as well as stuffiness due to swelling. Nasal drainage of blood and mucous is also common.

Swelling and congestion inside the nose usually last between two and three days, and drainage may continue for up to five days. Over - the - counter (OTC) medications usually suffice, but the surgeon may prescribe a pain reliever for the first day following surgery and a saline spray or irrigation treatment several times per day for the week following surgery to clear any nasal congestion. Full recovery generally takes one to two months. It is important for patients to follow the surgeon's orders during the recovery process, such as elevating the head, avoiding strenuous activity, and not pulling clothing over the head.

Spreader Grafts in Rhinoplasty

What are Spreader Grafts?

Spreader grafts are a surgical technique commonly used in rhinoplasty and revision rhinoplasty surgery. These grafts are made of cartilage, which can be harvested from the patient's septum, ear, or rib, depending on the amount of cartilage needed for the grafting purpose. In some cases, layered spreader grafts composed of multiple pieces of cartilage are used, especially for those who need significant widening of the dorsum due to a collapsed nasal vault resulting from previous rhinoplasty surgery, a deviated septum deformity, or for ethnic rhinoplasty patients with thicker skin.

The nose is divided into three parts: the top third, the middle third, and the bottom third (the tip). The middle third is composed of cartilage, which plays a crucial role in enabling the nose to breathe properly and comfortably while preventing nasal obstruction. If the horizontal cartilage in this area is too narrow, it can cause breathing problems. Spreader grafts are placed between the septum and the side or lateral walls of the nose to open up this area and support the side walls of the nose, preventing them from collapsing over time. They can also be used to widen the nose for a better aesthetic result, creating a more refined contour line from the forehead to the frontal tip (dorsal line).

What Do Spreader Grafts Treat?

• Correcting asymmetry issues in the middle third of the nose: Spreader grafts can help to balance the appearance of the nose by addressing any irregularities in the middle section.
• Refining the nasal tip: They can contribute to a more proportionate and refined nasal tip.
• Performing alar base reduction: In combination with other techniques, spreader grafts can assist in reducing the width of the alar base.
• Strengthening the middle third of the nose after hump removal or revision rhinoplasty: After procedures like hump removal, the middle part of the nose may need additional support, which spreader grafts can provide.
• Improving the airway at the nasal valve: The internal nasal valve is an important area for airflow. Spreader grafts can widen this valve, improving the patient's ability to breathe through the nose.
• Reconstructing a broken nose: In cases of nasal fractures, spreader grafts can be used to help restore the structure and function of the nose.
• Rebuilding a collapsed middle third: If the middle part of the nose has collapsed, spreader grafts can provide the necessary support to rebuild it.

Procedure of Placing Spreader Grafts

The placement of spreader grafts can be performed using either a closed or open rhinoplasty approach. The open approach is more common as it allows for better access to the middle vault of the nose. This procedure requires a small incision across the columella (the tissue between the nostrils) to lift the skin and expose the nasal structure. This allows for more accurate placement of the spreader graft. After obtaining the cartilage, the surgeon will create a customized spreader graft based on the specific needs of the patient. Once the graft is placed, it is sutured into its new location.

In patients with thinner - than - average skin, a temporalis fascia graft may be placed over the spreader grafts in the middle vault to provide extra cushion and prevent contour abnormalities.

Benefits of Spreader Graft Placement

• Restore or improve the brow - tip aesthetic line: The middle vault plays a major role in the cosmetic appearance of the nose, accounting for about one - third of the nasal bridge when seen from the frontal view. The ideal brow - tip aesthetic line is an imaginary curve that begins at the eyebrow and extends along the side of the nasal bridge and through the middle vault before diverging away from the nasal tip. Spreader grafts can restore this line if it is disrupted by an abnormal contour in the middle vault.
• Improve airflow for nasal breathing: By widening the internal nasal valve, spreader grafts reduce airflow resistance and improve the patient's ability to breathe through the nose. If the angulation of the valve is less than 10 - 15 degrees, achieving a 1 - 2 degree change in middle vault width by placing spreader grafts can make a significant difference in airflow.
• Reinforce weakened or collapsed nasal structures: They provide support to the nasal vault, especially in cases where the upper lateral cartilages are weak or have collapsed.
• Long - lasting results: Once the spreader grafts are placed and integrated into the nasal structure, the results can be long - lasting.

Recovery after Spreader Graft Surgery

After placement of rhinoplasty spreader grafts, patients usually return to work and normal activities within three weeks. However, it is recommended to avoid strenuous physical activity for 3 - 6 weeks. Swelling and bruising will begin to disappear within 2 - 3 weeks, at which time patients will start to see the initial results. Full results usually take 6 - 12 weeks to be visible, and the healing process will continue for the entire first year. The surgeon and their team will closely monitor the patient throughout this process.

Saddle Nose Repair (Cartilage Grafting)

What is Saddle Nose Deformity?

Severe saddle nose deformities are a result of anatomic changes to the nose structure. The nasal bone and cartilage have been damaged or lost, resulting in the collapse of the bridge and often a shortening of the nose and upturning of the nasal tip. This can be due to various reasons, such as trauma, previous unsuccessful nose jobs, or certain medical conditions.

Rhinoplasty versus Saddle Nose Surgery

Repairing a severe saddle nose deformity requires plastic surgery, but it is not a typical “nose job” or rhinoplasty. Most rhinoplasty procedures are used to reduce size, remove a dorsal hump, or create narrower nostrils. In a saddle nose deformity, the nose must be rebuilt as the septum and upper/lower lateral cartilage that support the nose have often been diminished. This is a much more complex process that requires cartilage grafting to restore the support of the nose before the shape can be addressed.

Procedure for Saddle Nose Repair

Cartilage can be harvested from a rib or ear and then carefully shaped and grafted to restore the nose structure. If there is a breathing obstruction, stents may be needed. After the structure is restored, the aesthetics of the nose must be considered to create a balanced nose that looks natural. Dr. Maurice Khosh, a highly experienced facial plastic surgeon in NYC, specializes in this complex type of nose reconstruction. He has achieved excellent results for his patients, despite the procedure being more difficult than conventional rhinoplasty.

Choosing the Right Surgeon in New York City

When considering nasal septal cartilage free grafting or any other nasal surgery in New York City, it is crucial to choose the right surgeon. Here are some factors to consider:

• Experience: Look for a surgeon with extensive experience in performing the specific procedure you are considering. For example, if you are looking for septoplasty, a surgeon like Dr. Philip Miller, who has over 20 years of experience in septoplasty, would be a great choice. Surgeons with a long - standing practice and a large number of successful procedures are more likely to have the skills and expertise to handle any complications that may arise.
• Board Certification: Ensure that the surgeon is board - certified in plastic surgery or a relevant specialty. Board certification indicates that the surgeon has met the rigorous standards set by the appropriate medical boards and has the necessary training and knowledge in the field.
• Reputation: Check the surgeon's reputation by reading patient reviews and testimonials. You can also ask for before - and - after photos of previous patients to get an idea of the surgeon's results. A good surgeon will have a positive reputation and a portfolio of satisfied patients.
• Personalized Approach: A skilled surgeon will take the time to understand your specific goals and concerns and develop a personalized treatment plan. They will also explain the procedure, its risks, and benefits in detail, ensuring that you are well - informed before making a decision.
• Communication Skills: Effective communication is essential between you and your surgeon. You should feel comfortable asking questions and discussing your expectations with the surgeon. A good surgeon will listen to your concerns and provide clear and honest answers.

Cost and Insurance Considerations

Cost of Septoplasty

The average cost of deviated septum facial plastic surgery (septoplasty) in New York City can range from approximately $4,000 to $10,000. However, this is just an estimate, and the actual cost can vary depending on several factors, such as the surgeon's fee, anesthesia, operating room fees, and post - operative care. To obtain an accurate estimate tailored to your specific nasal needs, including any potential rhinoplasty or additional surgical techniques, it is important to consult with your nose surgeon.

Insurance Coverage

Most insurances will pay for functional surgical treatments of the nose, such as septoplasty, if it is deemed medically necessary to improve the ability of the nose to work well. This may include cases where the deviated septum is causing breathing difficulties, recurrent sinus infections, or other health - related issues. However, cosmetic surgery (such as a purely aesthetic nose job) is never covered by insurance. Before undergoing the procedure, it is advisable to check with your insurance provider to determine your coverage and any out - of - pocket expenses, such as co - pays, deductibles, and co - insurance. Some clinics, like those in NYC, will help patients check their insurance benefits and keep them informed throughout the process to avoid any surprises.

Conclusion

Nasal septal cartilage free grafting and related nasal surgeries, such as septoplasty, spreader graft placement, and saddle nose repair, offer effective solutions for both functional and aesthetic nasal concerns in New York City. These procedures can improve breathing, correct structural deformities, and enhance the overall appearance of the nose. However, it is important to carefully consider the risks and benefits, choose a qualified and experienced surgeon, and understand the cost and insurance aspects.

If you are considering any of these nasal surgeries, we encourage you to take the next step. Schedule a consultation with a reputable plastic surgeon in NYC to discuss your specific needs and goals. Share this guide with others who may be interested in learning more about nasal plastic surgery, and continue to explore related topics to make an informed decision about your healthcare.