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Revision rhinoplasty and Revision septoplasty innovations with a PDS Plate

PDS Plates, the latest and greatest in revision rhinoplasty and septoplasty.

Two weeks ago I was lucky to get a sample of the new PDS plate to use in a tertiary revision septoplasty case. The PDS plate is made of the same material that is used in my favorite suture material for sewing cartilage in rhinoplasty. PDS suture material lasts around three months, long enough for healing and long lasting cartilage bonding to take place but not so long that the body rejects it and tries to “spit” it out. The PDS plate has been around in Europe for a number of years. European colleagues have talked about it in their lectures and published on it in 2005: Dr. Wolfgang Gubisch, Archives of Facial Plastic Surgery vol 7, July/Aug 2005 and Boenisch and Trenite also in Archives of Facial Plastic Surgery vol 13 Jan/Feb 2010.

Finally us of the PDS plate for nasal surgery was FDA approved for use in US early this fall. The parent company, Mentor, was well represented at the AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) meeting in Boston with very informed vendors and an armful of papers documenting the advantages of using PDS plates.

After all that fanfare, I had the ideal case 2 weeks following the meeting (2 weeks ago); a gentleman who had two prior deviated septum operations with persistent nasal septal deviation and nasal obstruction. What he needed was to have the septum taken completely apart and have something like this plate to hold the healing cartilages pieces in place as the septum heals straight. After all this buildup, I was told that they were back ordered and the product wouldn’t be available for many weeks. Well, it pays to have a good relationship with a superb rep. She was able to procure a plate for me in time to use for the surgery and I really think it will help get a superior result.

This weekend, I am an invited guest to go to St. Louis to hear lectures by the doctors who invented and perfected the use of the PDS plate as well as a lab demonstrating the many ways they suggest it can be used. Fortunately for me and my patient, I had a jump start on the process.

By the way, I already have my next case in mind. This is a 6 year old boy who smashed his nose last summer and had a failed attempt at fixing his destroyed septum. His nose is also collapsed. I believe the PDS plate will help restore a straighter septum nasal height with less surgery than he would otherwise require without it.

I really feel that the new PDS plate is an excellent new product that will help enhance the results in revision rhinoplasty and revision septoplasty.

Deviated Septum New York

Septoplasty Part II

Fixing a Deviated Septum

New York, NY – Fixing a deviated septum is usually performed from inside the nose by a closed or endonasal approach. Crooked bone and cartilage is moved, removed and/or straightened. There should NOT be any changes to the way the nose looks or any “black and blue” whatsoever. As I tell my septoplasty patients, your mother couldn’t tell that you had surgery 3 days later.  On the other hand, if you have a deviated septum it might be the ideal time to have a rhinoplasty if you have been thinking about it. Your surgeon will be operating in the neighborhood. Also, with modern rhinoplasty, often cartilage from the septum is used to strengthen the nose as we re-model it. Because of this, I suggest that if you are considering rhinoplasty and have a deviated septum, they should be performed at the same time. Other than the convenience of going through only one operation and one recover period, the fact that I often use cartilage from your septum to strengthen the nose during rhinoplasty is reason to do them together.

Please make sure that your surgeon looks inside your nose and checks for any causes of nasal obstruction; those that exist and those that may inadvertently occur during rhinoplasty. Based on Bernoulli’s Law of air flowing through a column, a minor asymptomatic deviation or other cause for obstruction can become more significant if the nose is narrowed. A rhinoplasty surgeon should be well versed in sinus surgery and all the associated consequences of functional nasal surgery.

A common misconception is that if you have or your doctor finds a deviated septum then you get a free or discounted nosejob. This might have been the case years ago. Insurance companies paid well and freely for nasal surgery. Doctors would call it a deviated septum and old nasal fracture or other creative names. Insurance companies got wise to this. Rhinoplasty is a cosmetic procedure and really isn’t the responsibility of your medical insurance company. Unless you broke your nose within the past year or so and have good documentation of a significant new deformity, don’t even think about it. There are some doctors who still add inappropriate codes to get higher reimbursement and others who will “throw in” a rhinoplasty if you have a deviated septum, but they aren’t necessarily the best surgeons. Be careful, you may get what you paid for: discount surgery.

There usually is some cost savings from doing a Septorhinoplasty together. Part of the operating room and anesthesia fees may be covered for the functional aspects of surgery. The functional portion of the Septorhinoplasty may also be covered by your medical insurance and may mean no or little additional cost beyond a cosmetic rhinoplasty for the functional (septoplasty) procedure. This depends on your insurance coverage.

 This is the nose that you will have for the rest of your life. You want it done once and done right. You should find the best surgeon you can, one who specializes in noses and does what is necessary to get a great nose. Steven J. Pearlman, MD, FACS

Septoplasty New York

Septoplasty – Deviated Septum Part I

New York, NY

What exactly is a deviated septum? How do I know if I have one? How did it happen? Will it change the way my nose looks if I have my deviated septum fixed, even if I don’t want to? Maybe I have one and no one knows? Will it get me a “free” or discounted nosejob?

These are just a few of the many questions patients and non-patients alike have when it comes to the elusive deviated septum. I will attempt to answer the above questions and more. My answers just kept on going and going so I am going to divide this into two parts.

The definition of a septum is a dividing wall. The nasal septum divides the two sides of the nose. The front 2/3 is made of cartilage and the back portion derived from two different thin bones. The septum sits in a groove of the bone that is above the palate of the mouth. When any or all portions of this structure are crooked, it is a deviated septum. We usually don’t even know when it became crooked. Maybe from falling on your face as a child, during sports or maybe even while you were being born; unless you can pinpoint a specific episode when you got hit in the nose followed by bleeding and a subsequently reduced airway.

Many people have crooked nasal septums and don’t know it. If there is no blockage of breathing or exacerbation of sinus and allergies then there is no need to worry or ever treat it. Many people have asymptomatic mildly deviated septums. The most common problem a deviated septum can cause is nasal blockage. If one side of your nose tends to be more blocked than the other, it is a high probability that you have a deviated septum. Other structures in the nose that can also contribute to blockage are called turbinates. These are curly bones that are covered with skin (mucosa) and tissue that swell with blood to warm and humidify the air we breathe. By the time air gets to your lungs it is 98% humidity and body temperature; most of this occurs in the nose. The turbinates work by swelling alternately, one side than the other. So, if one side is blocked then it alternates but you get good air through both together there really is no problem, just a normal nasal cycle. This cycle is even more evident at night, the “downhill” nostril swells. This is obvious when you turn over and the open nostril switches sides. If one side is almost always blocked, that means there is a fixed obstruction; a deviated septum or other abnormal structure such as a nasal polyp. Allergies, colds and other conditions that cause the inside of the nose to swell will also cause obstruction. This obstruction can be worse if there is also a deviated septum.  A deviated septum is diagnosed by a careful examination of the inside of the nose. Sometimes a CT scan helps delineate the back of the septum and can demonstrate possible associated sinusitis. Deviated septums can even be a cause of chronic headaches.

Sometimes a deviated septum may be asymptomatic. However a mild deviation can become a problem if the nose is made narrower in cosmetic rhinoplasty. This is why every rhinoplasty candidate should have the inside of their nose examined. If you see a doctor for a rhinoplasty and they don’t look inside your nose, it can lead to breathing difficulties after. Cosmetic rhinoplasty should go hand in hand with functional nasal surgery. It might not be necessary to address the septum, but it is important to make sure that it is not crooked; otherwise rhinoplasty may cause breathing difficulties. It amazes me that when I see patients for revision rhinoplasty with breathing issues how often they report that their prior surgeon never even looked inside their nose!

Steven J. Pearlman, MD, FACS

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