THE RHINOLOGIST is commonly consulted by a patient who has breathing problems due to a deviated septum, combined with a nasal deformity. A number of patients desire to have the septal deviation corrected at the same time as an operation to improve cosmesis. Previously this problem was dealt with in two stages. Originally the rhinoplasty preceded the submucous resection of the septum, for the reason that a later rhinoplasty and removal of dorsal hump would open into an excised area of the nasal septum and cause saddling. With experience this complication was found not to occur and for many years a submucous resection has preceded a rhinoplasty by a few weeks. Today, the surgery for these deformities is quite often performed in one stage. It is still not clear to what extent this can be safely done without endangering the support of the nose.
To further understand the structural problems
Clark GM. The Role of the Nasal Septum in One-Stage Rhinoplasty. Arch Otolaryngol. 1967;85(4):418–423. doi:10.1001/archotol.1967.00760040420015