There are nose jobs, and then there are nose jobs. Surgical revision of the nose may be purely cosmetic (rhinoplasty) or necessary to correct a functional problem caused by a genetic defect or trauma. And in some cases, the problem is both cosmetic and functional.

One of the most common types of medical issues that may cause functional and cosmetic concerns is deviation of the septum. Simply put, the septum is the cartilage wall dividing the nasal cavity into two nostrils. Ideally, the septum is centered so the nostrils are the same size and shape. However, the septum may be deviated, or off-center, due to congenital defects or trauma to the nose.

A deviated septum can cause an array of problems, says Dr. Mark Checcone, an otolaryngologist specializing in head and neck surgery with Washington University Physicians. “Functional problems are principally related to breathing obstruction or blocked nasal airflow,” he says. “When the septum leans to one side of the nose, more air flows to the opposite side, and there is a perception of insufficient airflow on the deviated side. More complex deviations can twist from the left to the right and cause both sides to be blocked.” Other functional problems include disrupted sleep, snoring, increased nose bleeds, drying or crusting of nasal mucus, worsened allergy symptoms, and blocked sinus passages leading to more sinusitis and poorly drained sinus passages, Checcone adds. From a cosmetic perspective, a severely deviated septum can result in a noticeably crooked or asymmetrical nose.

“Repairing a deviated septum (septoplasty) is often performed with rhinoplasty,” says Dr. Mike Nayak, a facial plastic surgeon with Nayak Plastic Surgery. “When rhinoplasty is performed, bits of cartilage ‘left over’ from repairing the deviated septum may be reused to create an attractively shaped nose.”

Nayak notes that straightening the septum is performed by removing or straightening the crooked cartilage. If no packing is used, there is generally little or no post-operative pain and no bruising. Most patients can return to work within a couple of days. When combined with rhinoplasty, external bruising is more apparent, and most patients need a week of recovery before resuming social activities and work.

“It is important for patients to understand that cosmetic changes to the nose are not covered by most insurance plans,” Checcone says. “Combining a cosmetic rhinoplasty with a functional septoplasty can improve both form and function without undergoing more than one surgical anesthetic and recovery period. The combination of surgery for medical and aesthetic purposes is routinely performed, and the costs of each portion are clearly separated. One should never undergo a cosmetic rhinoplasty without having a preexisting deviation of the septum corrected at the same time.”

In fact, Nayak notes that ‘the crooked cartilage pieces left over after the septoplasty are the best raw material for creating a pleasing nasal shape,’ which is another reason to combine the cosmetic and corrective procedures.

“If you suspect your septum is causing uneven breathing, difficulty breathing, sleep disturbance, increased sinusitis or frequent nose bleeds, it is best to have an otolaryngologist (ENT) evaluate you with a physical examination,” Checcone says. “Particularly if new symptoms arise following a trauma to the nose, prompt examination is important to ensure that the septum and other internal structures of your nose are healthy and functioning properly to keep you breathing freely.”