Tag Archives: better breathing

Nose Surgery: Snoring & Nose Woes

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"A wife is wide awake and angry over her husband's snoring"

Before Rhinoplasty?

Hopefully, female eyes will find this post — women are usually the sleep-deprived victims of a loudly snoring man.

Because we concentrate on reconstructive and cosmetic nasal surgery, we see many guys who come in for a rhinoplasty consultation. About half mention their snoring and ask if anything can be done during a nose job procedure to stifle the snoring.

Actually, a handful of conditions cause snoring but allow us to mention what happens just in the nose to cause the nighty log sawing.

The most common situation is a blockage in the upper nose caused by:

  • A once broken nose
  • Being born with a twisted nose
  •     “     sensitive to allergies
  • A bent, twisted or deviated septum

(The septum is the eggshell-thin partition of bone and cartilage between the nostrils.)

Because insufficient air travels through the nose and into the lungs while sleeping on the back, a patient must breathe through his mouth. The racket of snoring comes from tissues in the mouth flopping around with the airflow, sometimes stopping it.

The basic concept: “Healthy breathing is quiet; abnormal breathing is noisy.”

The mouth breathing of snoring also defeats three important nasal functions: warming, filtering and humidifying the air you breathe.

Snoring not only deprives care-worn mates of rest, it also deprives the snorer’s organs of healthy oxygen levels. Results? Daytime sleepiness, grogginess, low alert levels and, usually, falling asleep early in front of the TV.

Two other things can also stifle quiet healthy breathing: nasal polyps and enlarged turbinates, structures higher up in the nose that perform the warming, filtering and humidifying tasks.

Often, the turbinates react badly to allergies and swell, again blocking one or both breathing channels.

However, the news is far from all bad. Whatever the cause of the nasal blockage, an outpatient surgery can usually cure or greatly improve the condition, silencing the snoring.

To start, an exam of the nose, sinuses, throat and neck by a specialist in head and neck surgery is required.

In our practice, about half of cosmetic patients have breathing woes. Happily (and economically!) that functional surgery can be done in the same surgical session as a rhinoplasty.

Some find relief in deviated septum surgery.

Quipped a happy patient: “Doctor, you took my nose from a country lane to a four-lane super highway.”

Nose Surgery Can Mean Better CPAP Breathing

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"Two medical professionals give a lovely young woman a nasal exam"

Nasal Exam

Regular readers of our blog posts already know a CPAP is a face mask and machine for people who snore, often due to problems inside the nose that block healthy breathing.

But, as a curious cosmetic plastic surgeon, we also scan forums and bulletin boards for news about CPAP (which stands for “continuous positive air pressure,” a fancy way of saying “forcing air into your lungs through your nose”.)

So we note some users have found that nasal surgery makes their CPAP work even better.

The basic start of all this is raw snoring….ear-splitting, freight train decibel, nocturnal snoring that makes the bedroom curtains flap in the breeze and can be heard downstairs, if not the next house.  Pity the sleep-robbed mates of snorers.

Snoring can have many causes but some of the most common are:

  • A deviated septum
  • Swollen turbinates, structures higher up in the nose

A septum is the thin wall of cartilage that separates your two nostrils. When bent, twisted or otherwise deformed, they can block the breathing channels in the nose.

Turbinates warm and humidify the air you breathe. But they often react to allergies and other conditions by swelling, again blocking healthy, quiet breathing.

Curious about the numbers of healthy and blocked breathers, The University of Washington’s Sleep Disorders Center studied 306 CPAP users for two years. They wanted to find why some did not wear the CPAP mask regularly. (Read more about nose surgery and CPAP use.)

After exams, 108 patients showed abnormal nasal exams and were also the same group who did not use the mask correctly, if at all. The study authors concluded patients with abnormal nasal exams had decreased CPAP use and tolerance.

Concluded the authors: why not treat nasal conditions before prescribing a CPAP?

Yet another study at the Stanford Sleep Disorders and Research Center in Palo Alto, California, found that turbinate treatments, when appropriate, appear to benefit nasal obstruction and ease the breathing of CPAP users.

But before you say “yes” to a CPAP, ask yourself if any medical professional has actually looked up into your nose to see and diagnose the state of your nose and if its internal architecture allows for easy, quiet breathing.

Perhaps that would be the best first step possible!

Septoplasty & Turbinate Reduction Patients Speak

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"A beautiful woman shows only her nose and lips"

The function of the nose: to breathe

If you read plastic surgery bulletin boards and forums dedicated to people who have trouble breathing, you’ll discover that the real cause of their breathing woe is usually a surprise.

For instance, Kilgore T. writes: “I just had too many episodes of Afrin addiction due to swollen turbinates.”

(Background: turbinates are bony, flesh-covered structures high inside the nose. Turbinates often react to allergies and other “insults” by swelling and blocking healthy breathing.)

Afrin shrinks nasal tissues but has bothersome side effects like keeping you up all night because it’s an upper and causing mens’ sensitive tissues to swell.

The proposed solution to bugbear breathing: turbinate reduction surgery. Kilgore asks fellow bad breathing sufferers to:

Kilgore’s headline was: “Nose Surgery – CPAP usage and effect on apneas?” He’s asking if he would breathe well.

(Yet more background: CPAP, short for Continuous Positive Air Pressure is a machine that forces air through the nose and into the lungs; a CPAP is worn in bed at night.

Read more about CPAP and nose surgery.

Squid13 tossed in his two cents worth: “I had the surgery…they packed my nose with gauze for a couple of days and then removed it…in four to six weeks (the nose) good as new and boy did my breathing improve…make sure you go to a doctor who knows what he is doing, as too much turbinate reduction can lead to very deleterious results, i.e. empty nose syndrome.”

Added SleepingUgly: “I had septoplasty and turbinate reduction. It had great benefits to me (sic) in terms of being able to breathe through my nose…I have even gotten less sinus infections since the surgery.”

Commented Kitatonic: “(my doctor) stated nasal surgery should be done if the goal is to improve your daytime breathing.”

But Dale92 put a nice cap on Kilgore T.’s question: Pens Dale: “I had turbinate reduction on my right side and my deviated septum fixed in 2004. Before this, I was unable to breathe through my nose for most of my life except for periods of Afrin use which caused even more problems. Finally, I was able to breathe!…Like I said, it was the best thing I had ever done to improve my health…I would gladly do the surgery again.”

You can also have a cosmetic nose job during the same procedure.

(Read the internal nose surgery comments in full.)

A Cosmetic Plastic Surgeon: What We’re Thankful for

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"A thankful man crosses the fingers on both hands in thankfullness"

YE-S-S-S-S-S!!

At this time of year, when we’ve set aside a single day to acknowledge things for which we are thankful, some special ones come to mind.

Of course, everybody is thankful for engaging careers, interesting work, good health, solid family connections and the often mixed blessings of living in a wonderful nation.

But a few special things stand out.

While the anesthetic propofol got some bad press in the Michael Jackson death trial, the substance — in the right hands and in the right location — is a blessing for countless numbers of cosmetic plastic surgery patients who wake after surgery with clear minds and calm bodies.

We are also thankful for some space program spin-offs that make surgery safer for the patient while giving surgeons extra information and peace of mind.

Occupying only desk space, surgeons and anesthesiologists have information about the condition of a patient on the table they could only dream about 15 years ago. With a glance at the high-tech monitoring equipment, we can see:

  • The patient’s body temperature
  • Blood pressure
  • The amount of oxygen in the blood
  • EKG read-outs on cardiac health
  • Many, many more health metrics.

All that makes anesthesia in an accredited outpatient surgery center or hospital less risky than driving your car to the surgery!

We are also thankful for one particular patient, Todd, who agreed to a revision rhinoplasty. But before leaving, Todd asked if nasal packing would be placed in his nose after the procedure.

When we said yes, nasal packing is part of the surgery, he replied “Forget it!” and left.

Many patients say that nasal packing – cotton or other medical materials laced with medicine to hold everything in place inside the nose, prevent infections and staunch bleeding, if any – is like having a clothes pin on your nose for a couple days.

Some say nasal packing prevents them from sleeping; others report a feeling of claustrophobia. It means you must breathe only through your mouth and that leads to a dry mouth.

That started us thinking about nasal packing and patient comfort after a:

The result? The Kotler Nasal Airway (KNA) an FDA-cleared tube that allows patients to breathe normally and still have the nasal packing that promotes healing. (Read more about the Kotler Nasal Airway, pictured below.)

O.K. – your turn. What are YOU thankful for?

"Kotler Nasal Airway is show on a table and inserted in a patient's nose"

Kotler Nasal Airway -- in and out of a patient

Cosmetic Surgery Discounts

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"A stethoscope is seen laying on a stack of medical bills"

Cosmetic Surgery Costs

While Fox Business is reporting on the top 10 ways to pay for cosmetic surgery, they don’t mention any ways to trim the total costs of plastic surgery. (Read the top 10 ways to pony up for cosmetic surgery.)

If you know the natural up and down business cycles of rejuvenation surgery, you can arrange the procedure you want when cosmetic plastic surgeons will be very glad to hear from you and may consider trimming not only some sagging flesh, but the tab for it as well.

Some insurance-covered procedures produce a better function and a more pleasing appearance, including:

  • Nasal procedures inside the nose for people complaining of sinus-like symptoms. (Read more about breathing woe due to internal nasal structures.)

From November through the New Year, most facial surgeons are booked solid for patients requesting:

  • Eyelid lifts
  • Face lifts or rejuvenation by facial fillers like Restylane
  • Wrinkle removal

But the first two months of the New Year see fewer patients. Arrange your surgery then and ask about a discount of 20 percent.

Summer, however, is not a time to seek bargains, with many high school grads, before heading off to college, booking:

  • Rhinoplasty
  • Other facial procedures like ear pinning, or otoplasty

College grads are also in the mix, wanting an improved appearance before a serious job hunt.

Another excellent – and financially sound – way to spring for cosmetic surgery is to save up and pay by check or cash. Credit card companies charge the surgeon anywhere from three to five percent of the procedure.  Likewise a three to five percent discount from the surgeon is reasonable for full cash payment.

Smart consumers can also ask for surgery on a standby basis, with seven to 14 days notice before surgery.

Plastic surgeons arrange their surgery dates in advance. And the staff in an operating room must be paid, even if a patient cancels the surgery. But if a patient on the standby list can replace the cancellation, the operating room remains busy. A 20 to 25 percent discount for standby surgery has been granted by some surgeons.

A word about shopping for plastic surgery bargains: confine price comparisons to board-certified cosmetic plastic surgeons.

Why?

If a lesser-trained surgeon botches the job, your costs to repair the damage can be two to four times greater than the price of the first surgery!