I do septal surgery on most primary rhinoplasty and secondary rhinoplasty patients, either to harvest graft material or to clear the airway.  In our large airflow study, in place since 1991 and now including over 600 patients, we have discovered that septoplasty by itself, surprisingly, does very little.  Obviously if the septum is bent sharply toward the left, obstructing the left airway, and that is straightened, the left airway will work better.  However, total nasal airflow does not increase significantly.

Our experience with patients who have had a deviated septum and come to our practice, near the New Hampshire/Massachusetts border, has shown that septal surgery by itself does very little to improve total nasal airflow.  However, when patients have collapse of the sidewalls at either the middle third or the nostrils (which can occur in the unoperated nose but is even more common after rhinoplasty), airflow increases from two to four times in most patients.  Septoplasty done at the same time does not significantly improve the results obtained by valvular surgery alone, suggesting that correcting the valves is more important than correcting the deviated septum.

My success rate is extremely good with one operation.  Some years ago, our data showed that I had achieved what the patient considered subjectively normal airways, in one operation, in 93% of patients.  That number reflects 600 consecutive patients, and therefore includes both primary patients and those with severely damaged, previously operated airways.  The results of airway surgery in primary patients are close to 100% success.

After many years of writing textbook chapters for other multi-authored texts and writing many papers for the peer reviewed plastic surgery journals, I decided to write my own, single authored textbook.  At this point, there are very few surgeons at the national and international teaching level who perform rhinoplasty exactly as I do, and many residents are not being exposed to some of the best methods or to endonasal rhinoplasty. It seemed important to me to put down my 29 years of clinical experience in a single, two-volume text.  The book is entitled Rhinoplasty: Craft and Magic, and will be published in 2008 by Quality Medical Publishing, Inc.