plastic surgery questions
Dr. Houser, I have been told that it is best to have plastic surgery--if needed--before getting implants for ENS as plastic surgery changes the shape of airways. I am seeing a plastic surgeon at the Cleveland Clinic. He says I have a saddle nose deformity from the septoplasty, and that the surgeon did an osteotomy on my nose. He does not want to graft material to my nose. It would have to come from my ribs. I think it is because my eyes and face are still swollen from the surgery more than eight months ago. He wants to file down the nasal dorsum--I think it's the nasal dorum. It's some tiny bones protuding, and creating a hump, just below the bridge of my nose. He said that the muscle, soft tissue and cartilage covering the bones were removed in the surgery. I have been told by several people not to let anyone mess with the nasal dorsum, not let anyone file or reduce it. Then he would reshape what's left of my nose. The tip also sags due to lost cartilage. He would pull out the bones to widen it, and also to open the collapsed nasal valves. I don't see how the nose can be satisfactorily fixed without grafting cartilage, etc. Both he and my usual ENT now say I have ENS. The turbinates have shrunk way back since the healing of the long-term post-op infection. I know this is not your areas of expertise, but do you have any opinions about filing the nasal dorsum, pulling the bones out, not grafting, etc.? I will come to see you as soon as I can. I am switching insurance plans right now which postpones it. Thank you. kris

It is a bit out of my realm, but filing down a sharp boney rea is very appropriate. If the bone is collapsed inward then pulling it back out sounds correct as well. I cannot say about grafting the dorsum. It is often done in saddle deformity, but there are degrees of saddle nose. I cannot detect anything wrong in what they are suggesting from my knowledge of your case.

Dr. Houser, I forgot to mention that the dorsum area aches from the damage there. It's been over eight months since the surgery. People say pain is an indicator of a problem. Might this suggest that a structural repair, and not just cosmetic work, is needed? Saddling continues, doesn't it? Or does it stop if the condition is mild? It appears to me that my nose continues saddling. It would be awful to have the surgery and have the nose continue deforming. Thank you, kris

pain does not equate problem in a chronic setting I really cannot explain more you need to discuss that with the doc involved

Thank you.