Tag Archives: better breathing

After Deviated Septum Surgery

"A sleep deprived man wears a CPAP because he may have a deviated septum"

After visiting a doctor or nasal surgeon, some people find their “sinus problems” have actually been breathing problems caused by a deviated septum pushed, grown or knocked into a breathing channel in your inner nose.

Other symptoms may include:

  • Headaches
  • Nasal stuffiness & congestion
  • Nose bleeds
  • Facial pain

Another dead-bang clue can be a case of sleep apnea along with snoring. The most advanced cases tend to wear at night doctor-prescribed face mask devices –as in the picture above — known as CPAPs (Continuous, Positive Air Pressure) that force air through the blocked places in your upper nose.

(Read more about Deviated Septum Surgery.)

While the surgical procedure to repair a deviated septum can require three to 10 days of recovery, some daily self-care can speed things along. Among the many items of self-care:

  • Keep your head higher than your heart while resting or sleeping and ask for a laxative, if needed. The idea is to get good bed rest and sleep.
  • Nasal saline solution can relieve congestion and loosen nasal crusting, if any. Keep crusting at bay with Vaseline on a Q-tip; hydrogen peroxide works, too. Afrin spay may help along with a room humidifier.
  • If you had a Septorhinoplasty (deviated septum surgery plus a nose job in the same surgical session) and you have an incision on the outside of the nose, gently clean it with a Q-tip soaked in hydrogen peroxide; apply antibiotic on the incision per your surgeon’s instructions.

(Learn more about Septorhinoplasty)

  • To reduce facial swelling, use an unopened bag of vegetables or an ice pack.
  • Change saturated gauze packs under your nose; most bleeding stops within two days.
  • Don’t blow your nose for ten days.
  • Don’t stifle a sneeze; instead sneeze through an open mouth.
  • If you have a Kotler Nasal Airway (KNA), call his office or read online how to clear the tubes.

(Read more about the Kotler Nasal Airway)

  • Avoid smoking, smokers, dust, fumes and other irritants that could cause an infection.
  • Hold off on your exercise schedule for 10 days.  But walking is good; also stay out of the sun for six weeks and use a sun block on the nose thereafter. Because intimate relations relations raise blood pressure and can lead to bleeding, delay making whoopee during that same 10 days.
  • Brush the teeth with care; the upper teeth will be tender and numb for several months.
















Hearing Woe Due to Nasal Blocks?

'A sketch of the inner nose shows the location of the Eustachian Tube"
Eustachian Tube, lower right

Our sister blog (robertkotlermd.com/blog) recently told the story of Kevin Spacey’s broken nose and how he discovered the four and one-half-year-old break because he was having — get this — hearing trouble.

           (Read about Spacey’s onstage broken nose.)

While we did not examine Spacey, it is possible a person with a clogged or blocked nose to also developed clogged ears and possibly report some trouble hearing.

A nose can be clogged for many reasons, the most common of which is a bent, or medically, deviated septum, which usually blocks healthy breathing and drainage.

          (Learn more about the deviated septum & clear breathing.)

At the time, it did not dawn on Spacey he had broken his nose after the accidental nose smack.

Nasal obstruction can also mean the lining of the nose is swollen into the breathing channel. You may have heard of the Eustachian tube, a small tunnel in the back of the nose that leads to the ears. And perhaps you have “popped” your ears in the past to clear them. Well, that pop was a Eustachian tube clearing.

And all that fits in with Spacey’s broken nose that was unknowingly allowed to heal in the broken position.

But if you can no longer clear that tube, you may have a condition medically known as Eustachian tube dysfunction. It involves more than just mucous in the tube.

Here’s what else happens to a patient with blocked breathing; he or she creates with each breath negative pressure in the back of the nose right where the Eustachian tube is found. That negative pressure can travel up the tube to the ear and cause the person to feel like an ear is somewhat blocked.

Result? Sounds are somewhat muffled and unclear.

“All this also means that if the breathing obstruction in the nose is treated, clogged ears will be better as well,” writes Christopher Chang, M.D. an ENT (ear, nose & throat) specialist near Washington, D.C.

Plus, a test of 114 nasal patients with blocked breathing in one nostril or the other showed that hearing troubles occurred on the same side of the head as the nasal block.

                    (Read the nasal blocks breathing study.)

Deviated Septum: Not Always a Nose Job Too

"Jennifer Aniston shows her before and after nose job picturees"
Before and After Nose Job (right)

It seems there may be something in Hollywood’s water that causes a deviated septum. Because Tinsel Town is having a rash of deviated septum cases that appears to have also resulted in a nose job like the lovely Jennifer Aniston, pictured above. Note how her nose became slimmer after, ah, deviated septum surgery.

Don’t get us wrong – such a nose surgery combination is often done. But mostly to celebrities? Probably not.

Surgery for a deviated septum happens after the septum, that paper-thin cartilage divider of your two nostrils gets knocked from its center position and blocks a breathing channel. Such surgery is known as functional and not cosmetic.

          (Read more about deviated septum surgery.)

But while you’re under the knife for functional surgery, why not go ahead and have a rhinoplasty if you don’t like the shape of your nose?

Combining a nose job with deviated septum surgery is known as a Septorhinoplasty.

Pictured just below, note how the multi-talented Carmen Diaz also had a much thicker nose in years gone by. After, ah, deviated septum surgery, her nose became much more refined, fit her face better and made her eyes more alluring. ______________________________________________________________________

"Carmen Diaz before and after a nose job"
Before and After Rhioplasty


         (Look at some non-celebrity nose job before & after pictures.)

Fergie, (Stacy Ann Ferguson) the singer with Black Eyed Peas and Allure’s cover girl for February, 2015, also shows very minor touches on her rumored rhinoplasty which was billed as a time out for surgery on that acursed deviated septum. In the before (left) picture, her nose appears to have a more pronounced hump and her nasal tip points down more on smiling.


"Fergie shows her nose, before and after a nose job"
Rhinoplasty, Before & After (right)


Josh Hutcherson, pictured below, late of the Hunger Games, also wrote off some kick back time behind closed doors as a deviated septum surgery recovery.


"Josh Hutcherson shows his nose job, before and after"
Nose Job, Before and After (right.)


His nose job – which the Hollywood rumor mill has endlessly reported – was mostly work done around the nasal tip and nostrils. A slimmer looking and a nose fitting his face well resulted.

Good thing Beverly Hills, the world’s hot spot for excellent cosmetic plastic surgery is cheek-by-jowl with Hollywood, huh?

Botched Nose Jobs

"A Rugby player shows his thrice broken nose in a close up"
Twisted outside = Twisted Inside

The most recent episode of Botched, the E! Channel’s latest offering of plastic surgery tales in the “Golden Ghetto,” (Beverly Hills) introduced Paul, a late 20 or 30-something married guy who had suffered, not one, but two botched nose jobs.

The most recent left his nose twisted to the left; moreover, he had a noticeable hump on his nose. So he was in for a revision nose job.

          (See some before and after revision nose job pictures.)

Among plastic surgeons, a common saying is: “A nose twisted on the outside is almost always twisted inside, too.”

Besides looking a tad strange, it means that Paul’s breathing is also affected. Additionally, he suffered chronic migraine headaches that left him tired and unable to play with his children as much as he would like. Functional surgery straightens out the breathing channels

          (Read more about functional surgery.)

But aren’t two botched nose jobs unusual?

Actually, one of the major professional societies for facial plastic and cosmetic surgeons estimates that 20 to 25 percent of all nose jobs are botched. Rhinoplasty is immensely difficult and not a job for beginning surgeons.

          (Read more about the high rate of botched nose jobs.)

So many botched nose jobs creates a huge need for revision (medicalese for a surgical re-do) nose jobs, which are harder yet. And even some of the revisions are revised. Top Beverly Hills nasal surgeons often see patients with anywhere from three to seven previous failed nose jobs.

         (Learn more about revision rhinoplasty.)

Sure enough, when the plastic surgeon duo stars of Botched peered into Paul’s nose, they found his septum leaning far into a breathing channel.


On the first  picture panel  Paul shows his crooked nose. The second before  and after profile panel  shows the hump removal. (E! Channel Photos)










Paul thought the surgery was going a little far because the surgeons needed some rib-donated cartilage to straighten Paul’s nose. It’s commonly done in rhinoplasty surgery, but Paul’s wife was a bit alarmed.

Said one of the Beverly Hills plastic surgeons: “Paul is a handsome guy, but his nose is basically on the left side of his face!”

True enough to the half hour T.V. segment, Paul’s cosmetic and functional nose surgery features were all resolved in thirty minutes.

In real life, a patient like that can go out in public again in, say, five days after a nose job while your revised nose should be pretty presentable within eight days including bruise remediation, if any. Still more healing goes on for a year.

Septoplasty & Turbinate Surgery = Good Breathing

"A surgeon works during turbinate reduction surgery"As a fitness and nutrition coach, 27-year-old Whitney DeLong could tell her bodybuilding students to breathe deeply, although she couldn’t follow her own advice.

In fact, she could barely breathe at all. Whitney found out she was on the wrong track when her allergy specialist told her he, the specialist, could do no more for her and that she should find a good ENT (ear, nose and throat) specialist.

Due to allergy complaints, Whitney had been getting allergy tests, allergy shots, prescription nasal sprays, pills and breathing treatments. All without relief.

“I was used to people constantly asking me if I had a cold or needed a cough drop,” Whitney says. “There was rarely a day in my life I COULD breathe normally.”

Many people with breathing woes often go down the wrong path because they think the problem is sinus.

Whitney did know from one CAT scan, she had a severely deviated, or bent, septum leaning strongly to the right in her nose.

“I later learned a deviated septum can block the breathing channel,” Whitney says.

It must have been a serious block because nose surgery was scheduled on the same day as the initial consultation with the surgeon who added another procedure.

Due to Whitney’s allergies, some internal nasal structures – the turbinates — in her nose had also been swelling and adding even more blockage to her breathing channels.

The procedure, turbinate reduction surgery, slims down the problem blockage. Skin covering turbinates is especially rich in blood so usually some bleeding follows the procedure.

(Read more about Whitney’s turbinate reduction surgery.)

Most nose surgeons apply a thick absorbent pad just under the nose across the lip in turbinate reduction. The patient then changes the pad at home.

(Learn what to do after turbinate reduction surgery.)

Turbinate skin is like no other in the human body. Because the job of the turbinates is filtering, warming and moisturizing the air you breathe, skin covering the turbinates can swell up tremendously and then shrink later.

(Read more about septoplasty and turbinate reduction surgery.)

Functional Surgery: Most Patients Rue Waiting

"A young woman is shown in her office burying her head in her hands"
Why Did I Wait so Long?

Some of the most common remarks made after nose surgery by “functional” surgery patients are: “Why-oh-why did I ever wait so long!” or “I wish I had this done years ago!”

(“Functional Surgery refers to nose surgery procedures that makes the nose better able to perform its basic function – breathing.)

Some waited for a long while because they were born with a breathing blockage and knew no other way. So for them it was not a question of getting older and more decrepit.

Suffering the effects of bad breathing for many years is fairly common among patients who have:

  • A deviated septum
  • An uncorrected broken nose
  • Allergy-enlarged turbinates

Along the way, the usual suspects show up: snoring and irate bedmates, frequent sinus infections, sleep apnea and perhaps use of a CPAP (Continuous, positive air pressure) machine.

(Read more about the relationship between the need for functional surgery and CPAP machines.)

Part of the problem rests with the so-called “gatekeeper” doctors who are family practitioners or internists in charge of referring their patients on to specialists, if needed.

Those “gatekeepers” should be able to recognize a deviated septum, a twisted nose or enlarged turbinates in the upper nose and see that a blockage of healthy breathing is possibly present.

Simply put: it’s not normal to have lousy breathing.

The next step would be referring that patient to an expert nasal surgeon who would know what to do.

Some patients who have bemoaned a long period of extended bad breathing then become the happiest patients on earth when:

  • The deviated septum is corrected
  • Enlarged turbinates are trimmed
  • A crooked nose is straightened
  • A rhinoplasty is also done

All the above only takes a single, two-hour session to better the person’s quality of life for the rest of his or her days. Plus, the patient’s facial appearance is vastly improved.

One patient actually explained why he had waited so long to have functional surgery to improve his breathing.

He heard from other rhinoplasty patients that the nasal packing inserted into the nose after nose surgery was pure misery, causing mouth breathing for five days.

After seeing many patients turn away from surgery due to nasal packing (which is great for holding everything in place and delivering medicines that help the nose heal better) we invented a slim airway known as the Kotler Nasal Airway.

Nasal packing is now wrapped around the airway, allowing the best of both worlds – breathing and healing.

Plastic Surgery’s Only Real Plastic

"A woman lifts her head to show a septum leaning into and blocking a nostril"
Deviated septum, left. After surgery, right.

Plastic surgery articles almost always carefully point out that the “plastic” in plastic surgery comes from the Greek word plastikos which means, “to mold or take form.”

Nonetheless, many blog authors use the word plastic in the sense of artificial.

But there is one place in reconstructive plastic surgery  (as opposed to cosmetic plastic surgery) where actual plastic is used – in nose surgery to restore healthy breathing.

Your nose is divided into two breathing channels we know as the nostrils. The septum, a thin wall of cartilage and bone separating the nostrils, is often found to be warped, twisted or otherwise bent like in the before and after picture above.

Nose surgeons then refer to it as a deviated septum and dislike it intensely because it interferes with healthy breathing by limiting the air you breathe through at least one nostril.

And because the nose is a three-dimensional structure, the septum also acts to support the nose.

Some people are just born with a deviated septum while blows to the nose in accidents and sports create many more.

So where does the real plastic part come in?

When doctors repair a deviated septum in nose surgery, they often use stitches to restore the septum to the midline of the nose. To hold everything in place during healing, nose surgeons use plastic splints, a type of rigid implant made of soft silicone plastic. But the splints don’t stay in the nose forever; they are usually removed in one to three weeks.

Yet another condition known as nasal valve collapse also uses real plastic. In some cases, too much of the septum has been previously used as a building material during previous cosmetic nose surgery.

(Read more about deviated septum revision and nasal valve collapse.)

In other cases, the nose has been hit especially hard and collapses into a so-called “boxer’s nose” or a “pug nose.”

In both cases, breathing troubles are usually present. Besides, it looks bad.

Some surgeons take cartilage from patents’ ears or from between the ribs to use as supports in the nose. But that creates more surgical wounds.

Other nose surgeons now use polyethylene plastic inserts to repair a nasal valve collapse. The inserts are measured for each patient’s nose and then stitched to the septum for extra support.

In a 36-month Veteran’s Hospital study of 18 patients who had noses repaired using the technique, 15 had excellent results according to a recent article in The Archives of Facial Plastic Surgery. In one patient, the plastic graft poked through the nose skin and two were removed.

The remainder said their breathing was significantly better.

(Read the nose surgery report.)

Nose Surgery & the 5-Day Afrin Test

"A lovely woman is shown holding her nose due to stufiness"
                Constant Stuffy Nose

Many patients come into the office for a cosmetic rhinoplasty appraisal and are surprised to learn they have conditions inside their noses impairing healthy, normal breathing.

While getting the patient’s medical history some clues emerge: Usually the patient (along with the bedmate!) is plagued with loud snoring and sleep apnea. Maybe a CPAP is used.

Many are sensitive to allergies that cause upper nose structures known as turbinates to swell and again block breathing.

(Turbinates: bony structures in the upper nose that warm and filter your air. The turbinates are covered by a unique type of skin that can swell many times its normal size.)

Some patients have suffered a broken nose that’s healed in the broken position, again blocking good breathing.

But which is it, deviated septum, sensitive turbinates or a twisted or crooked nose? And who wants to undergo internal nose surgery for only slight relief?

A simple at-home test helps pinpoint the bugbear: the five-day Afrin test. For a short while, that test mimics the results of surgical enlargement of the nasal passages.

The demonstration could use any decongestant although Afrin, the most popular and common, along with its generic cousins, shrink the nose skin of the turbinates and the septum.

Watch for the following signs: if the patient:

  • Sleeps better
  • Has less daytime fatigue
  • Snores less or none

an inner nose procedure to improve breathing will most likely go well and be effective.

Here’s how the five-day Afrin test is done:

  1. Assign somebody at home to report on snoring
  2. Patient starts by sniffing five sprays into each nostril
  3. Watch a clock and let five minutes pass
  4. Repeat step 2.
  5. Do that for five days
  6. Separate the spraying episodes by eight to 12 hours

If, after five days, the in-house observer reports less snoring while the patient has more daytime energy, less nasal blockage, fewer headaches and a halt or reduction in sleep apnea, the Afrin has worked.

It’s because the decongestant reduces all the tissues lining the nose’s inside. However, Afrin has proportionally more effect on the lowest turbinate, the one that is usually surgically reduced in size for airway improvement.


Surgical correction of the deviated septum and trimming of the lower turbinates is almost assured to improve all the energy-draining symptoms of bad breathing listed above.

Of course, the 5-day test won’t do anything for the appearance of the nose; rhinoplasty is required for nose shaping.

Nose Surgery: Snoring & Nose Woes

"A wife is wide awake and angry over her husband's snoring"
Before Rhinoplasty?

Hopefully, female eyes will find this post — women are usually the sleep-deprived victims of a loudly snoring man.

Because we concentrate on reconstructive and cosmetic nasal surgery, we see many guys who come in for a rhinoplasty consultation. About half mention their snoring and ask if anything can be done during a nose job procedure to stifle the snoring.

Actually, a handful of conditions cause snoring but allow us to mention what happens just in the nose to cause the nighty log sawing.

The most common situation is a blockage in the upper nose caused by:

  • A once broken nose
  • Being born with a twisted nose
  •     “     sensitive to allergies
  • A bent, twisted or deviated septum

(The septum is the eggshell-thin partition of bone and cartilage between the nostrils.)

Because insufficient air travels through the nose and into the lungs while sleeping on the back, a patient must breathe through his mouth. The racket of snoring comes from tissues in the mouth flopping around with the airflow, sometimes stopping it.

The basic concept: “Healthy breathing is quiet; abnormal breathing is noisy.”

The mouth breathing of snoring also defeats three important nasal functions: warming, filtering and humidifying the air you breathe.

Snoring not only deprives care-worn mates of rest, it also deprives the snorer’s organs of healthy oxygen levels. Results? Daytime sleepiness, grogginess, low alert levels and, usually, falling asleep early in front of the TV.

Two other things can also stifle quiet healthy breathing: nasal polyps and enlarged turbinates, structures higher up in the nose that perform the warming, filtering and humidifying tasks.

Often, the turbinates react badly to allergies and swell, again blocking one or both breathing channels.

However, the news is far from all bad. Whatever the cause of the nasal blockage, an outpatient surgery can usually cure or greatly improve the condition, silencing the snoring.

To start, an exam of the nose, sinuses, throat and neck by a specialist in head and neck surgery is required.

In our practice, about half of cosmetic patients have breathing woes. Happily (and economically!) that functional surgery can be done in the same surgical session as a rhinoplasty.

Some find relief in deviated septum surgery.

Quipped a happy patient: “Doctor, you took my nose from a country lane to a four-lane super highway.”

Nose Surgery Can Mean Better CPAP Breathing

"Two medical professionals give a lovely young woman a nasal exam"
Nasal Exam

Regular readers of our blog posts already know a CPAP is a face mask and machine for people who snore, often due to problems inside the nose that block healthy breathing.

But, as a curious cosmetic plastic surgeon, we also scan forums and bulletin boards for news about CPAP (which stands for “continuous positive air pressure,” a fancy way of saying “forcing air into your lungs through your nose”.)

So we note some users have found that nasal surgery makes their CPAP work even better.

The basic start of all this is raw snoring….ear-splitting, freight train decibel, nocturnal snoring that makes the bedroom curtains flap in the breeze and can be heard downstairs, if not the next house.  Pity the sleep-robbed mates of snorers.

Snoring can have many causes but some of the most common are:

  • A deviated septum
  • Swollen turbinates, structures higher up in the nose

A septum is the thin wall of cartilage that separates your two nostrils. When bent, twisted or otherwise deformed, they can block the breathing channels in the nose.

Turbinates warm and humidify the air you breathe. But they often react to allergies and other conditions by swelling, again blocking healthy, quiet breathing.

Curious about the numbers of healthy and blocked breathers, The University of Washington’s Sleep Disorders Center studied 306 CPAP users for two years. They wanted to find why some did not wear the CPAP mask regularly. (Read more about nose surgery and CPAP use.)

After exams, 108 patients showed abnormal nasal exams and were also the same group who did not use the mask correctly, if at all. The study authors concluded patients with abnormal nasal exams had decreased CPAP use and tolerance.

Concluded the authors: why not treat nasal conditions before prescribing a CPAP?

Yet another study at the Stanford Sleep Disorders and Research Center in Palo Alto, California, found that turbinate treatments, when appropriate, appear to benefit nasal obstruction and ease the breathing of CPAP users.

But before you say “yes” to a CPAP, ask yourself if any medical professional has actually looked up into your nose to see and diagnose the state of your nose and if its internal architecture allows for easy, quiet breathing.

Perhaps that would be the best first step possible!