What is a Functional Rhinoplasty?
Rhinoplasty, or “nose surgery” has often been considered simply as a cosmetic elective procedure. However, the audience should be aware that there is an entire category of nasal surgery, called “the functional rhinoplasty” in which the goal is to improve the breathing through the nose.
Select below to learn more about specific problems that can be corrected with functional rhinoplasty:
- Sleep Apnea and Snoring
- Broken and/or Crooked Nose
- Aging and Nasal Obstruction
- Deviated Septum
- Nasal Valve Collapse
- Mouth Breathing
How do I know if I am a patient who will benefit from functional rhinoplasty?
Many people deal with nasal airway obstruction. The most common causes include environmental allergies or common cold which will resolve either with time or with medical treatments. However, for a subset of patients, the structural or the anatomic aspect of the nose is the cause of nasal airway obstruction. These people will benefit from functional rhinoplasty based on medical necessity.
Generally, patients have already undergone medical treatments from their primary care providers, for example, allergy test and/or allergy medications. However, if patients continue to have problems despite medical treatments, or if a physical exam or imaging study reveal obvious structural problem with the nose, they will benefit from functional rhinoplasty.
Some patients have collapsing of the nose when they are inhaling deep or rapidly. These are called dynamic nasal valve collapse. Others may notice pitched appearance or crooked appearance of their noses at rest, with constant blockage at all time.
One quick test to know whether patients have nasal valve problem is if they have noticed improvement with “Breathe-right” strip (nasal splint). Or some patients will lift up their cheeks to flare open their nostril to help them breathe.
Another tool that our office use is a questionnaire called, the “NOSE Survey”. This is a validated instrument and used by academic researchers and surgeons to score the severity of nasal airway obstruction.
Over the past ONE MONTH, how much of a problem were the following conditions for you?
Score 0 (not a problem) - 4 (most severe problem)
- Nasal congestion or stuffiness
- Nasal blockage or obstruction
- Trouble breathing through the nose
- Trouble sleeping
- Unable to get enough air through the nose during exercise or exertion
Stewart MG, Smith TL, Weaver EM, et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004; 130(3): 283-290
What is involved in functional rhinoplasty?
Most commonly, we will start by addressing the septum, the wall that separates the left and right nose. If there is deviation or irregularity of the septum that is causing blockage of the nasal airway, we will correct that often by removing the involved segment of the cartilage.
Next, we will address the nasal valve. This may be as simple as improving the strength of the nose, by using the septal cartilage to create a graft – which is like an internal “breathe-right” strip. Other times, we may need to widen the internal nasal valve – again most often using the patient’s own septal cartilage as a graft.
What is the difference between Cosmetic Rhinoplasty and Functional “Medical Necessity” Rhinoplasty?
A cosmetic rhinoplasty is performed for the purpose of improving the appearance of the nose, whereas functional rhinoplasty is performed to improve the function (breathing) of the nose.
The most common indication for functional rhinoplasty is for patients who have chronic obstruction of the nasal airway. Nasal airway obstruction can be due to many reasons, including seasonal allergy and/or structural deformity of the nose. If the cause of nasal airway obstruction is due to structural problem of the nose, then surgical treatment will offer the best chance of improvement for the problem.
There are numerous causes for structural issues of the nose that can lead to nasal airway obstruction. These include, a history of trauma to the nose, hereditary or congenital (some are just born with it), chronic inflammation, or as part of the aging process.
Prospective patients who are inquiring about functional rhinoplasty will undergo medical evaluation including endoscopic examination, and sometimes CT imaging. Dr. Kim belongs to a unique group of plastic surgeons with training and expertise to simultaneously address the problems inside your nose and the outside appearance of the nose.
This is a 13 year old patient who came to see Dr. Kim for a problem related to her nose. She was born with deformity of the nose and the septum which had completely sealed shut the left nasal airway and started growing into the cheek bone causing facial pain. This patient underwent functional rhinoplasty including extracorporeal septoplasty. Left pictures are pre-operative, and right pictures are 1 month after the surgery. Immediately after the surgery, she was able to breathe through her nose – first time ever – and facial pain had improved also.
This is a 25 year old patient who came to see Dr. Kim for a problem related to his nose. The patient had a history of numerous sport-related traumas to his nose, and now was dealing with chronic obstruction of his nasal airway. One can also appreciate the external crooked appearance of the nose. The patient underwent functional septorhinoplasty. Immediately following his surgery the patient began to breathe through the obstructed nasal passage (his right). Subtle improvement in external appearance is also appreciated. Pictures on the right are about 1 month after the procedure.
This 71 year old patient was dealing with chronic nasal obstruction on her right side. Upon careful examination, it was determined that her outer nasal valve on her right side was collapsing in when she breathed in air. Patients with this type of problem will often notice marked improvement when using Breathe Right® strips which serves as a splint to keep their nasal valves open. This patient underwent a procedure where her septal cartilage was borrowed (cartilage can come from either the nasal septum or the ear), and inserted into the right supra-alar area of the nose to strengthen and prevent the valve from collapsing during breathing.
What does the surgery entail?
Depending on the nature of the repair, it can take as quick as under an hour, to sometimes two hours or more. Sometimes, the surgery can be done with no visible incisions outside, other times there will be a small incision under the nose which will heal to a point where it’s almost invisible.
Will the surgery change the appearance of my nose?
If the patient already presents with a crooked nose, improving the function of the nose will often improve the crooked appearance of the nose as well. This is because, even though the goal of functional rhinoplasty is to improve the function of the nose and not the appearance, often times deformity and dysfunction are directly related.
Now some patients may inquire about combining this with a cosmetic procedure to alter the shape of the nose at the same time – most common requests includes refining the tip, or removing the hump. This is often times performed during functional rhinoplasty, but the cosmetic part of the procedure will be considered elective and will not be covered by the insurance. The total cost of the cosmetic component of surgery will be clearly disclosed to the patient during the consultation visit.
Double board-certified Facial Plastic Surgeon Dr. Sang W. Kim at Natural Face Clinics specialize in aesthetic enhancement of the face, head, and neck, exclusively. Patients come to see us from the Syracuse metropolitan area and Central New York area including Ithaca, and Rochester. At Natural Face Clinics, we specialize in restoring the youthful neck contour, tired appearance of the brows and eyes, and skin laxity. We offer customized treatment, both surgical and non-surgical, including facelift, eyelid surgery (blepharoplasty), nose surgery (rhinoplasty), brow lift, neck lift, and skin resurfacing. Find out more by scheduling your personal consultation today.