Sinus surgery can be safely performed at the same time as rhinoplasty. If the surgeon is skillful in the performance of both of these procedures, then this can be undertaken by a single surgeon, but if not, there is certainly a skillful surgeon in your area who can do this for you.

This combined surgery can compose as much as 18%-20% of a surgeon’s practice (personal communication from Dr. Paul Toffel). In my practice, approximately 12% of patients who undergo sinus surgery also undergo rhinoplasty. For those of you who are interested, this information is more fully detailed in the journal, Aesthetic Surgery, where Dr. Kennedy and I wrote an article entitled “Indications forEndoscopic Sinus Surgery in Patients Seeking Aesthetic Rhinoplasty.”

We often see patients who have had previous rhinoplasty, and if – unfortunately – they have had too much cartilage taken out from the nose they can have nasal collapse.

As shown here, when this patient breathes in through her nose has complete collapse of her nostrils. This is treated by restoring structural support to her nose. This can be done by a very simple outpatient procedure under sedation anesthesia, and you can see that on these pictures that the strength of her nose is restored.

A few years ago, we published an article entitled “Clinical Study of Alar Anatomy and Surgery of the Alar Base.” In this report we examined the features of the noses of 100 randomly selected patients. What was important here is that the nostril is of “normal” thickness and strength in about 73% of the patients but was thin and weak in 20%. In other words, in this particular sampling 20% of the patients have thin, weak nostril margins. It is important for the surgeon to identify these patients pre-operatively, and then you must be especially careful that you don’t resect too much. You would probably want to resect a little bit less than usual in these patients to avoid this sort of problem, because this can result not only in nasal obstruction but also in an unsightly cosmetic appearance.

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