Breathing through your nose is one of those basic things you take for granted until you can’t do it anymore. Guest host Laura Cain talks with facial plastic surgeon Dr. Kiersten Riedler about nose surgery, specifically the septoplasty and rhinoplasty surgeries she does to fix the inside and outside of the nose.
If you’re used to going through life with restricted nasal passages, you might not even realize how much better it could be. The septoplasty is surgery to straighten or correct a deviated septum, while a rhinoplasty is surgery to change the shape of the nose for either cosmetic or functional purposes.
If someone wants to change the inside of their nose as well as its outside structure, it can be done in two surgeries, but it’s preferred to do them together (septorhinoplasty) because it’s less time under anesthesia, less recovery, and easier on the surgeon.
Laura asks Dr. Riedler all the questions people are too afraid to ask, from the impact of past cocaine use on the inside of her nose to her honest thoughts on Michael Jackson’s nose.
Even though nose surgery looks dramatic on tv shows like Botched, it doesn’t require a hospital stay and Dr. Riedler reassures us that it’s not that scary and you can go home the same day.
Dr. Riedler discusses the ins and outs of recovery after a rhinoplasty and septoplasty, where to find reliable information about nose procedures, the revision rate for nose procedures, septal perforation caused by addiction and whether it is fixable, and more.
Laura Cain (00:07):
You’re listening to The La Jolla Cosmetic Podcast.
Laura Cain (00:15):
Hello. You’re listening to The La Jolla Cosmetic Podcast and I’m Laura Cain. I don’t usually host this podcast. It’s Monique Ramsey who hosts it, but she is out because she has no voice and she may be out for a few weeks. So you might have to deal with me, but if you don’t know who I am, I used to work with Jeff and Jer, and now I’m on Star and other various radio stations. I have a podcast too, and I am a big-time patient of La Jolla Cosmetic. I’ve had so many things done with my friends over there. The most recent thing I did were threads, which I am in love with. And I’m sure Monique has another podcast all about threads. In fact, I know she does. I also got a breast augmentation in September, and there’s a three-part podcast about that too. So I’m very familiar with the whole cosmetic surgery world. So I’m honored to be hosting this podcast today. And our guest is Dr. Kiersten Riedler. Dr. Riedler, you are new at La Jolla Cosmetic. Talk about who you are and what kind of doctor you are.
Kiersten Riedler (01:23):
Hi. Thanks for having me. So I am a facial plastic surgeon and I’m actually originally from San Diego. I was born at Scripps La Jolla. Grew up here, then went away for school. I went to Harvard for undergrad. I went to USC in LA for med school and residency. And then I did an extra fellowship in facial plastic and reconstructive surgery at UC Davis. And now I’m here. I’ve been in San Diego for a few years now, but I’m really glad to be back here in my hometown. And I’m really excited to be joining the team at La Jolla Cosmetic Surgery Center. We just really have a great team and they have an amazing practice. I personally think it’s the best one in San Diego and that’s why I’m here.
Laura Cain (02:13):
Me too. And you have some really great learning under your belt. I mean, we went to Harvard. My daughter and I did a tour of Harvard. She thought she might want to go there, and it is outstanding.
Kiersten Riedler (02:23):
Yeah. I loved it back there.
Laura Cain (02:25):
Very, very exclusive. I mean, you have to be incredibly smart to be in Harvard plus USC. Anyway, so I’m very impressed, but what we’re really going to focus on today is septoplasty. And if you’ve never heard of septoplasty, what exactly is that?
Kiersten Riedler (02:42):
So the septum is a wall of bone and cartilage that separates the two sides of the nasal cavity in the nostrils, and it’s one of the fundamental supporting structures of the nose. So septoplasty is surgery to straighten or correct a deviated septum, which is a crooked septum that is shifted towards one side of the nasal cavity that can potentially cause blockage of the nasal airway or also deviation of the bridge or the tip of the nose.
Laura Cain (03:14):
How does one know if they have something going on with a deviated septum? And how do they know if they need a septoplasty?
Kiersten Riedler (03:21):
Depending on what part of the septum is crooked, it can cause breathing problems or cosmetic problems or potentially both. And so patients often will complain of difficulty breathing through one side or both sides of the nose. Really the only way to know for sure if you have a deviated septum is to be examined by a specialist like me, but that might be a tip off if you have either a crooked nose or you’re having trouble breathing through your nose, it may be due to deviated septum.
Laura Cain (03:50):
Does this affect the outward appearance of your nose?
Kiersten Riedler (03:53):
It can. So the septum actually goes right up to the nasal bones. And so a crooked septum can actually make you have a crooked nose externally as well.
Laura Cain (04:06):
If somebody wanted to just get their deviated septum fixed and not change the structure of their nose on the outside, can you do that?
Kiersten Riedler (04:16):
Typically, that’s possible. It depends what part of the septum is crooked. So if the part that’s further back that just affects the breathing more so is crooked, then a septoplasty alone without changing any of the external appearance of the nose is a great option. If the part that’s crooked is closer to the outside of the nose, especially if it’s a part right in between the nostrils, then sometimes you actually do need to do what’s called a septorhinoplasty surgery to change the shape of the nose and the internal septum in order to straighten it.
Laura Cain (04:53):
If a person wanted to change the inside of their nose as well as the outside structure, say, get a nose job, is that two different surgeries?
Kiersten Riedler (05:02):
So it’s better if it isn’t two different surgeries. Potentially it can be done as two different surgeries. However, I always recommend to patients that if they need a septoplasty and want to change cosmetically the appearance of their nose, that they do it together as a septorhinoplasty surgery because it’s less time under anesthesia. It’s less recovery. And it also makes my job easier because if I am going to do a rhinoplasty on somebody who’s already had a septoplasty, there’s probably going to be less cartilage available for grafting, and there’s already going to be scar tissue. And so I think for the best outcome in terms of breathing and appearance, it’s ideal to do the two surgeries together. It’s important to go to a surgeon who is board-certified in plastic surgery or facial surgery because they have special expertise in septorhinoplasty surgery and know what they’re doing, essentially.
Laura Cain (06:08):
Can all plastic surgeons do septoplasty?
Kiersten Riedler (06:11):
So septoplasty alone is typically done by an ear, nose, and throat surgeon or facial plastic surgeon, whereas rhinoplasty is usually done by a plastic surgeon or facial plastic surgeon. So I am an ENT and facial plastic surgeon. So I’ve done a lot of septoplasties, a lot of rhinoplasties, a lot of septorhinoplasties. And I think that my experience dealing with surgery inside of the nose and including sinus surgery, septoplasty nasal reconstruction, helps me a lot as a rhinoplasty and septorhinoplasty surgeon because I have a really good understanding of the nasal structure and function inside and out.
Laura Cain (06:50):
Okay. As a former user, I’ve been 15 years clean, but I know a lot of people in my program who have used so much over the years that they’ve damaged the inside of their noses. Do you see that a lot from cocaine use? Does it damage the inside of your nose badly?
Kiersten Riedler (07:08):
Yeah, I do see that fairly frequently. What cocaine does is it shrinks the blood vessels and reduces the blood supply to your septum. And so it can cause that tissue to basically disappear over time, resulting in a hole in your septum or what we call a septal perforation. Definitely not everybody who’s ever used cocaine or even heavily used cocaine is going to end up with that, but it definitely can happen and it can cause problems like crusting or dryness, mucus buildup, bleeding, and it can also potentially affect the appearance of your nose and cause the deformity called a saddle nose. So that’s something that can be fixed.
Laura Cain (07:53):
Oh, I was going to ask you, can it be fixed?
Kiersten Riedler (07:54):
Yeah, it usually can. If a perforation is more than two centimeters in size, generally we aren’t considering that patient a candidate for repair. But if it’s smaller than that, which usually it is, it can be fixed.
Laura Cain (08:10):
Okay. I always thought that getting a nose job or anything to do with the nose is the most difficult part of the face to work on. Is that true? Is it the most difficult kind of surgery of the face?
Kiersten Riedler (08:22):
It is a pretty complex structure because of all of the small parts involved. There’s small bones, cartilages, skin, soft tissue, and it’s important to consider not just the appearance, but also the function. So it does make for a pretty complicated area to work on. And because it’s the center, most prominent part of your face, it’s an important feature that is going to affect the appearance of your face and also your quality of life because of its function in breathing and moisturizing the air and all of that. So I don’t know if I can say it’s the most complicated part, but it’s up there, for sure.
Laura Cain (09:07):
Yeah, because everybody’s just so different. But do you use ear cartilage or rib cartilage to fix the interior of the nose?
Kiersten Riedler (09:16):
So the septal perforations, the holes in the septum, that’s definitely a case where we would usually need rib cartilage to fix it. In other cases, it really just depends on the patient. It’s going to be more often revision cases or in patients who want to augment the nasal bridge that we would need rib cartilage or ear cartilage. But definitely when somebody’s had surgery before or they just need to build up the outside of the nose, we like to take cartilage from the ear or the rib because it’s a natural source for grafting as opposed to silicone or some other foreign object.
Laura Cain (09:59):
I watch a lot of the shows like Botched-
Kiersten Riedler (10:02):
Laura Cain (10:03):
… where they show it really in depth. I mean, they show the nose job. And I think a lot of people get scared or may be scared. Maybe they are having trouble breathing and they know they need to get something done, but they’re terrified you’re going to lift up their nose, it’s going to look all weird, and it’s going to take forever to recover. Is that true?
Kiersten Riedler (10:22):
Rhinoplasty and septorhinoplasty is a small area, and it’s a lot safer than other major surgeries. There’s not a lot of blood loss. You can walk and move around after. You don’t need to stay in the hospital after. So even though it looks very dramatic on TV-
Laura Cain (10:42):
It does look dramatic.
Kiersten Riedler (10:42):
… it’s really not scary. And recovery is really not all that bad. You have some swelling and bruising for a week. But after that, even though you’ll have some swelling, you can go outside and nobody’s going to look at you like something just happened.
Laura Cain (10:59):
If somebody were to think, “Okay, I think I’m into this. I like it. I want to look more into it.” Should they Google it? Or where would you send them to look at for more examples and maybe some visuals?
Kiersten Riedler (11:12):
The academy websites. So the websites for the American Society of Plastic Surgeons, the American Academy of Facial Plastic and Reconstructive Surgeons. Those are typically good places to go for reliable information that’s really helpful for patients. Some other sources may or may not have good information. It’s hard to know. So I always like to recommend those sources.
Laura Cain (11:38):
And do you have to have this surgery done again or is it one and done?
Kiersten Riedler (11:43):
Typically, it’s one and done. On average, the revision rate is about 5%. So maybe 1 in 20 patients undergo revision surgery, but typically it’s a one-time thing.
Laura Cain (11:53):
Okay. And besides maybe an accident or maybe being hit in the nose or something or cocaine use, what else causes deviated septums?
Kiersten Riedler (12:03):
Usually it’s just congenital. Everybody has some amount of facial asymmetry. And so that might contribute to it. Or potentially birth trauma. Generally your septum is fully formed by the time you reach adulthood and the septum won’t change a whole lot after you reach adulthood, but the outside of the nose can change with age.
Laura Cain (12:26):
I know. I’m dying to ask you questions about rhinoplasty and the nose, but I don’t know if I’m… I’ll ask you one question. So I’ve noticed that the older I get, the more prominent my nose gets, and it’s becoming wider. I have a very wide nose bridge as it is, but is that true? Does that happen? And why?
Kiersten Riedler (12:49):
So the nose doesn’t grow as we age, but the structure of it does change to some extent because the cartilage loses collagen and elastin. It becomes more floppy or saggy. And then the skin also gets thinner, less elastic. And so the nose tends to droop a bit as we age and flatten and can appear bigger as we age, even though it’s not actually growing.
Laura Cain (13:22):
Do you think Michael Jackson had any kind of interior nose structure at all at the end?
Kiersten Riedler (13:30):
Probably very little.
Laura Cain (13:31):
Because once that’s gone and once you don’t have that, you have no nose, right? It’s important.
Kiersten Riedler (13:37):
Yeah. I have done cancer reconstructions and cases where basically a patient has no nose, and we rebuild a nose from their own tissue, but-
Laura Cain (13:50):
That must be so satisfying.
Kiersten Riedler (13:52):
Yeah. It definitely is.
Laura Cain (13:54):
Really cool to see that.
Kiersten Riedler (13:55):
Laura Cain (13:56):
So what is recovery like? How long does it take to fully recover from a septoplasty?
Kiersten Riedler (14:03):
So you have typically splints on the inside of the nose that are soft rubber for about a week, and those come out on your first post-op visit.
Laura Cain (14:13):
Does that hurt?
Kiersten Riedler (14:15):
Not really. It’s a little uncomfortable, but it’s really quick, and people usually are pretty happy when they can breathe, especially if it’s for the first time. So it’s generally an overall positive experience.
Laura Cain (14:27):
Okay, good. Yeah. I’m sure. Anything I’ve ever had done cosmetically at La Jolla Cosmetic has been an awesome experience, even the needles. I love it. It’s like, bring me in a big bowl full of needles and I’m fine with it.
Kiersten Riedler (14:42):
Yeah. We definitely make you comfortable.
Laura Cain (14:44):
In the end, it’s going to look so awesome. And yes, you do make us comfortable. And with COVID still lurking around, do you do virtual consultations for a septoplasty?
Kiersten Riedler (14:55):
Yes. We can do virtual consults. Definitely before signing somebody up for surgery, I’d want to take a look in their nose, but as a first visit, we definitely offer virtual consults.
Laura Cain (15:07):
So how many visits are we talking? The initial online visit, and then the in-person looking at the nose, and then the surgery?
Kiersten Riedler (15:15):
And then usually we have you come in for a pre-op visit to go over all the instructions and get you ready for surgery.
Laura Cain (15:24):
And then post-op.
Kiersten Riedler (15:25):
Yeah. And then the post-op.
Laura Cain (15:27):
Okay. Is there anything else you want to say to anybody who may be considering getting septoplasty?
Kiersten Riedler (15:33):
If you have a deviated septum and you’ve been thinking about changing the shape of your nose, septorhinoplasty is a really good option and it isn’t scary. Like I said, it’s a really safe surgery. It’s outpatient. So there’s definitely nothing to be afraid of. And it’s not as dramatic as you see on TV.
Laura Cain (15:52):
And think how much better you’re going to feel and breathe and all that oxygen to your brain. It’s going to really help you.
Kiersten Riedler (15:59):
I mean, patients after surgery are really happy. I saw a patient a week or two ago who said it’s like a whole new world because she never knew that she could potentially breathe like that through her nose. And yeah, patients say that all the time.
Laura Cain (16:14):
I think that’s it with any kind of cosmetic surgery. It’s life-changing in the best way. It just helps your whole outlook on life. I mean, I got a breast augmentation. How’s that going to change my life? But it did. Things feel better. I’m more confident. I’m getting more things done. It sounds weird, but you know what I mean.
Kiersten Riedler (16:32):
Yeah. It changes your overall sense of self and self-confidence and it has a huge effect on your life.
Laura Cain (16:37):
And the only place you want to get it done is La Jolla Cosmetic. Trust me. Trust me and Kiersten Riedler. Thank you so much for being on with us. I know that you are very busy and so we really appreciate it. And welcome to La Jolla Cosmetic. We hope that you’re here forever and ever, and-
Kiersten Riedler (16:55):
Thank you so much for having me. It was great to talk to you and see you because I’ve heard you on the radio for many years.
Laura Cain (17:01):
Oh my gosh.
Kiersten Riedler (17:04):
I feel like I’m meeting a celebrity.
Laura Cain (17:05):
When you were 14, whatever.
Kiersten Riedler (17:06):
Laura Cain (17:07):
Oh my gosh.
Kiersten Riedler (17:09):
Yeah. Jeff and Jer.
Laura Cain (17:11):
Oh my God. You know you’re old when your doctor’s younger than you now. Oh gosh, that hurts. But no. Thank you. I appreciate it. And if you’re listening today or if you love the LJC podcast or if you’ve learned something from it, if it helped you make a decision, tell your friends and write a review of the show. We love our reviews at La Jolla Cosmetic. We have over 5,000 five-star reviews. So go ahead and read some of those reviews if you’re interested in getting something like this done. If you have any more questions or you want to do scheduling or something, just go to the website. It’s glamfam.com is where you go. And there’s a treatment planner on there too where you can figure out other things you might want to get done. So thank you for listening to the La Jolla Cosmetic Podcast. I’m Laura Cain, the fill-in for Monique Ramsey, who usually hosts this. And thank you, Kiersten Riedler. Have a great day.
Kiersten Riedler (18:06):
Thanks so much.
Speaker 3 (18:13):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code podcast to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego freeway in the XIMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram at LJCSC. The La Jolla Cosmetic Podcast is a production of The Axis, the axis.io.