Jay M. Dutton, MD FACS
The term rhinoplasty in general refers to plastic surgery performed to make changes to the internal and external structures of the nose. While this may be performed for purely cosmetic reasons to improve appearance, often the primary or simultaneous goal is to restore the ability to breathe through the nose. In this case, the surgery is more specifically referred to as a functional rhinoplasty. This is different from a septoplasty, which involves only repair of the internal wall that divides the nasal cavities, or from a cosmetic rhinoplasty, which is done to improve appearance. A functional rhinoplasty typically involves repair of the nasal valves, which is the medical term for the internal cartilage valves within the nostrils. These can be congenitally narrow(meaning you are born that way), collapse with age, or can be scarred from prior surgery. While surgery on the nasal valves is usually performed to restore breathing, it typically necessitates some type of change to the appearance of the nose.
The indications for a functional rhinoplasty include, but are not limited to:
- Obstructed nasal breathing (functional)
- Nasal injury (trauma) causing unsatisfactory breathing
- Nasal birth defect impairing function
- Acquired deformity due to trauma, tumor or infection
- Narrowing, collapse or stenosis of the nasal valves (nostrils)
A functional rhinoplasty
may be performed under different types of anesthesia depending on patient and physician preference, including local anesthesia (i.e. patient awake but with “numbing medications”), intravenous sedation (i.e. “twilight”) or general anesthesia (i.e. completely asleep). Incisions are made to allow access to the underlying cartilage and bone. These incisions may be hidden completely inside the nostrils, or involve internal incisions combined with a tiny incision through the skin at the base of the nose.
Often cartilage and/or bone may need to be obtained from another site to help gain support. These cartilage grafts are often taken from the nasal septum during the septoplasty
portion of the procedure, although sometimes ear or even rib cartilage may need to be harvested. Further reshaping or grafting may need to be performed with sutures to the cartilage, or sutures to reshape or suspend the cartilage. Osteotomies
– or deliberate fracturing of the nasal bones – may be performed to straighten the nasal bones if they are crooked or deformed. Although cartilage grafting remains the most common type of functional rhinoplasty, procedures to reshape the nostrils (ex: a “z-plasty”) or the use of sutures and screws to suspend the nasal tissues have grown in popularity.
At the conclusion of the procedure, the outside of the nose is often taped and some form of external cast may be applied. Plastic sheets and/or packing may also be temporarily placed inside the nose depending on the procedure and the surgeon’s preference.
Studies have shown that most functional rhinoplasties heal without serious problems or complications and the majority of patients are able to breathe better and enjoy an improved quality of life. However, there are potential complications that every surgical candidate should be aware of before proceeding with the procedure which include (but are not limited to):
- Complications of anesthesia
- Epistaxis (nosebleed)
- Septal perforation (hole in internal wall of the nose)
- Unsatisfactory appearance
- Need for revision surgery
- Worsening (rather than improvement) in the nasal breathing.
An improvement in nasal airflow is the primary benefit of a rhinoplasty performed for functional reasons. The procedure may also straighten the nose, repair post-traumatic or congenital deformities, and improve the appearance.
A functional rhinoplasty
is a procedure to improve the function of the external nose, and the surgeon may use a great range of techniques depending on the patient’s goals, the anatomic problems, and the surgeon’s preferences. The procedure may be done with the patient awake or under anesthesia and as a primary or revision surgery. It may involve cartilage grafting, and the recovery time may vary depending on the severity of the problem. Patients should be prepared to discuss their specific goals with their surgeon. After their consultation they should understand the procedure itself, as well as its risks and its benefits. They should understand that even if they undergo this type of surgery with the goal of improved nasal breathing, this may involve a modest alteration in the appearance of their nose.
©American Rhinologic Society