Plastic surgery on the nose, or rhinoplasty, may be performed to improve the size/shape/elegance of the nose or to improve breathing…OR both.
Let's have a look at the difference between functional nasal surgery to improve breathing and cosmetic rhinoplasty to improve the nasal appearance and how the two may be related to each other.
Nasal Anatomy
The nose consists of a bone and cartilage framework with skin covering it. The two nasal passages are separated by a septum that goes down the middle of the nose and extends all the way to the back of the throat. There are other structures within the nose called turbinates that also affect airflow and breathing. It gets a little complicated because the internal anatomy that determines breathing and the external anatomy that determines appearance are usually, but not always, completely separate. The septum that divides the two nasal passages can also affect nasal appearance because certain types of deviated or crooked septums can cause the nose to be crooked on the outside. So it is possible to have a deviated septum that obstructs breathing AND causes the patient to have cosmetic concerns.
Functional Rhinoplasty
Many people have nasal anatomy that makes it difficult for them to breathe through the nose. Often these patients snore and wake up with a dry mouth from the inability to breathe through the nose while sleeping. If the nasal septum, which is just a partition between the right and left nasal passage, is not straight (known as a deviated septum), breathing may be limited. The septum may be leaning to one side causing airway obstruction on that side. Septal deviations can even cause an obstruction on both sides if the shape of the septum is like an “S”, where it blocks one side the swings over, and blocks the other side as well. Breathing may also be compromised by the collapse of the nose when the patient breathes in. This can be the result of previous nasal surgery or may simply be due to the patient’s anatomy. Finally, the patient may have enlarged turbinates on the inside of the nose that limit the airflow.
Functional rhinoplasty is a plastic surgical procedure that attempts to relieve breathing difficulties and consists of one or a combination of the following: septoplasty to relieve the deviated septum, reduction of the turbinates on the inside of the nose, or strengthening of the external parts of the nose to prevent collapse on inspiration.
Cosmetic Rhinoplasty
Cosmetic rhinoplasty, as the name suggests, is performed to make the nose look better. It improves the nose's aesthetics by resizing, reshaping, and enhancing the overall elegance of the nose.
Most patients choose cosmetic rhinoplasty for:
Rhinoplasty is one of the more difficult cosmetic surgical procedures and requires a skilled and experienced plastic surgeon with expertise in aesthetic surgery of the face and nose. If performed by a non-specialist, the results may not be ideal, and a revision rhinoplasty may be necessary.
Revision rhinoplasty or secondary rhinoplasty is a second surgical procedure done to improve the result after an initial rhinoplasty procedure. Secondary rhinoplasty is even more complicated than first-time or primary rhinoplasty.
Combination of Functional and Cosmetic Rhinoplasty
Of course, many patients have their breathing problems and cosmetic concerns addressed during the same operation. The cosmetic portion is not covered by insurance while the functional portion may be covered. The overall time of the operation (say, two hours) is divided between the aesthetic portion and the functional portion and may be dealt with separately by the surgeon’s office, anesthesiologist, and facility. As mentioned above, the more complicated situation is when the functional portion and cosmetic portion are related; for example, when the deviated septum is causing airway obstruction AND causing the nose to be crooked. This is the one situation where the patient may receive a cosmetic benefit (straighter nose) that is covered by insurance because the breathing is being improved by the same procedure. More commonly the cosmetic portion and breathing portion are separate.
Consult a Plastic Surgeon
Consult a plastic surgeon with training and experience in cosmetic and functional rhinoplasty to explore your options and answer your questions.
Dr. Charles Thorne is a leading name in the world of aesthetic plastic surgery and a rhinoplasty specialist. Get an online consultation with Dr. Thorne to see if you are a candidate for cosmetic or functional rhinoplasty…or both!
Dr. Thorne is the Editor-in-Chief and the author of several chapters in Grabb and Smith's PLASTIC SURGERY, 7th Edition.
