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I am currently considering surgery on my nose.

Your questions answered by our surgeon, Lucian Ion, FRCS(Plast)

Asked on 19 October 2011


I am currently considering surgery on my nose, however I am probably going to be a challenging patient!

I am 52 years old and have had SLE for about 15 years, but as of August 09 I suffered a collapse with a severe Lupus flare, frighteningly in May '10 I started having severe epistaxis which continued for about 3 months.

I then had severe nasal blockage due to inflammation and swelling, I have historically had a deviated septum and in the late 70's I had a minor Rhinoplasty.

Returning to present day, I have had steroids and methotrexate to relieve the sinus issues but sadly its now chronic. My horror now, is that I have a massive perforated septum with now a slight 'saddle' nose, or dip in the bridge. The bleeding has stopped completely now, but I am left with the septum (or lack of) and breathing and aesthetic issues.

I have researched your procedures and have so far felt a confidence, I am aware that all patients are individual and you need to examine someone to fully assess what can be done, but can I ask you what your thoughts are initially and if you would consider I would be a patient you could help?

I do bruise very easily and tend to bleed in surgery also. I am fearful of the inability to breath post op as this is now a huge problem for me and very distressing. I hope I have given you enough initial information for you to reply?


For the problems related to breathing and sinus congestion, an ENT examination would be necessary to establish the degree of the problem and some possible treatments. In the interim, I would suggest using saltwater rinse for the nose and sinuses, the most commonly available in the UK being Sinus Rinse from Neilmed.

With regards to the septal perforation, I think it is best left alone as the repair is complex and would not be suitable to undertake in someone with significant SLE problems.

The damage to the septum has left the bridge of the nose without support, hence the saddle nose deformity, and this is typically repaired using rib cartilage graft. Again this sounds inappropriate in the context of associated risks, but one of the alternatives would be represented by injectable fillers to the bridge of the nose to create a degree of bridge contouring.

In terms of the surgical risks, to a great extent they depend on how well the SLE is controlled, and your rheumatologist should be advising on this matter.

All in all, it would be preferable for the surgery to take place through the NHS so that you can have full support of collateral services, and I would suggest that you discuss it with your GP for an ENT referral. If they can contribute to stabilising the nasal airway it would have a significant benefit to your quality of life.

You do need to bear in mind that the general risks related to bleeding, infection and deep vein thrombosis are significantly higher in the context of autoimmune diseases like SLE.

Lucian Ion Cosmetic Surgeon Mr Lucian Ion FRCS(Plast)
129 Harley Street

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