What is a deviated septum?
You may have been told, “you have a deviated septum.” What does this really mean? The nasal septum is what divides the nose into a right and left nostril. The septum is a wall or partition inside the nose. It is made up of cartilage in the front and thin bone in the back of the nose. When the septum is straight, air is able to flow freely through the nasal passages. When the septum is crooked or ‘deviated,’ air flow through the nose can be blocked. Not only can air flow be blocked, but mucus can be blocked as well. Our nose makes mucus to protect us. Mucus traps bacteria, viruses, and allergens. These pathogens are cleared from our body when mucus can flow normally. A deviated septum can block normal outflow of mucus and make allergies or infections worse.
If you’ve ever struggled to rinse your nose with saline rinses or spray medication, it may be due to a deviated septum. Deviations in the septum can prevent nasal medications from reaching the far back areas of the nose needed to fully treat allergy or nasal congestion symptoms.
When to seek an evaluation for your nose
You may benefit from an evaluation if you have difficulty breathing through the nose, nasal congestion, bloody noses, or post-nasal drip. In some cases, a severely deviated septum can contribute to other problems like snoring, sleep apnea, and sinusitis. If you have seasonal allergies, a deviated septum can make symptoms worse. Some women experience worse nasal congestion during pregnancy called, pregnancy rhinitis. This is due to increased blood flow and swelling of the nasal tissue inside the nose.
What does a nasal evaluation look like?
Your primary care doctor may refer you to a nasal specialist like an Ear, Nose, and Throat surgeon or a Facial Plastic Surgeon. An evaluation of nasal breathing can be easily performed in the clinic. Sometimes a nasal endoscopy or small camera inside the nose is useful to determine if the septum is deviated far back in the nose or if there are any other problems. This is not painful and typically takes just a minute or two.
How is a deviated septum treated?
If the septum is severely deviated the usual treatment is called a Septoplasty surgery. This is a relatively short surgery that involves making hidden cuts inside the nose to straighten or remove the crooked parts of the nasal septum. If the septum is not deviated, then the underlying cause of nasal congestion needs to be treated. For example, seasonal allergies can cause nasal blockage and is commonly treated with nasal rinses, nasal sprays, and anti-allergy medications. Even more specific allergy testing and treatments can be done in some cases.
Some people will ask to have to have a rhinoplasty surgery or ‘nose job’ surgery at the same time as a septoplasty. The reason for this is fairly straight forward. The incisions needed to perform a septoplasty are often the same or at least similar to the ones needed to perform a rhinoplasty. Even more importantly, the cartilage that is taken out during a septoplasty is sometimes needed during a rhinoplasty surgery. If the surgeries are done at the same time, the cartilage that was removed to improve breathing can also be used to alter and improve the appearance of the nose.
When considering whether to have nasal surgery, be sure to speak with a nasal surgeon who performs a thorough nasal exam and can provide a specific explanation for your nasal obstruction. There are many reasons you may have difficulty breathing through your nose and no two noses are the same!
Roxana Moayer, MD is a facial plastic and microvascular reconstructive surgeon. Her clinical specialties include treatment of facial nerve disorders and synkinesis, facelift and neck lift, rhinoplasty, blepharoplasty, brow lift, cosmetic facial skin treatments including microneedling and PRP, facial reconstruction (following trauma and cancer), hair restoration, facial feminization, and otoplasty. She is dedicated to helping patients look like the best version of themselves, driven by a strong belief that such work is inextricably linked to their self-confidence and overall health. Her attention to detail and aesthetic eye, paired with advanced training in cutting-edge techniques, allows her to deliver reliable, safe and natural-looking results.
After completing her medical doctorate at the Keck School of Medicine of USC, Dr. Moayer continued to the University of California, Los Angeles to complete her internship and residency. From there, she moved to Philadelphia for an additional year of training at one of the highest volume, AAFPRS-accredited fellowship training programs in the country, Jefferson Facial Plastics. She is currently an assistant professor on faculty at the Keck School of Medicine in the Department of Otolaryngology Head & Neck Surgery.
Dr. Moayer is also involved in the Face-To-Face program, an organization affiliated with The Break the Silence Foundation against domestic violence that provides plastic surgery treatment for survivors of domestic abuse.