Cosmetic Rhinoplasty vs. Functional Rhinoplasty vs. Septoplasty

Written by Minas Constantinides, MD, FACS, Board Certified Facial Plastic Surgeon on January 14, 2020 No Comments

rhinoplasty vs septoplasty
Most people consider nose surgery to be synonymous with cosmetic rhinoplasty, a plastic surgery procedure strictly dedicated to enhancing the appearance of the nose. While cosmetic rhinoplasty continues to be a very popular plastic surgery procedures, there are two other nose surgery procedures (functional rhinoplasty and septoplasty) that have a focus on improving the functionality of the nose.

This post will provide a detailed overview of the differences between cosmetic rhinoplasty, functional rhinoplasty, and septoplasty procedures.

Quick Comparison Chart

Cosmetic Rhinoplasty Functional Rhinoplasty Septoplasty
Purpose Cosmetic Improvement Functional Improvement Functional Improvement
Enhances Nose Appearance Yes Maybe No
Improves Breathing No Yes Yes
Area Altered Outer Structure Outer Structure Septum and Inner Structure
Technique Closed or Open Closed or Open Endonasal
Scarring Minimal (between nostrils) Minimal (between nostrils) No Visible Scarring
Covered by Insurance No Partially or Fully Covered Partially or Fully Covered

Procedure Purpose

Cosmetic rhinoplasty is a purely cosmetic procedure performed to improve the appearance of the nose. It can alter the nose in many ways including:

  • Correcting the angle of the tip (e.g. rotation)
  • Reducing and improving nasal tip size and symmetry
  • Reducing or raising nasal bridge height (i.e. removing a hump)
  • Straightening nasal bridge (if crooked from injury or development)
  • Altering the size of the nostrils
  • Lengthening and/or widening the nose

Cosmetic rhinoplasty can also be performed to correct any aesthetic issues caused by injury or prior surgery. The final result of good rhinoplasty is a more harmonious union between the face and the nose while enhancing facial symmetry. Cosmetic rhinoplasty is performed when breathing is normal. Today’s techniques help prevent breathing from becoming worse; as previously covered it cannot correct a deviated septum.

Functional rhinoplasty is a surgical procedure that is primarily performed to correct various breathing constriction issues due to weak nasal walls or previous trauma. Functional rhinoplasty can be performed to repair nasal valve deformities in order to restore proper breathing. While functional improvement is the primary goal of functional rhinoplasty, cosmetic improvements to the nose may occur as a happy consequence since the procedure can improve nasal symmetry.

In contrast to the aesthetic improvements provided by cosmetic rhinoplasty and (potentially) functional rhinoplasty, septoplasty solely improves the functionality of the nose. Septoplasty corrects a deviated septum and improves nasal breathing. This procedure repositions and/or removes bone and cartilage from the space between the nostrils to correct misalignment. The result of septoplasty is more open nasal airways for easier breathing. The outside appearance of the nose will be totally unchanged. Septoplasty is commonly performed in conjunction with functional rhinoplasty since septal deviation is often accompanied with nasal valve stenosis; both surgeries are required in these cases, performed at the same time, so nasal airflow is maximized.

Area Altered

Both cosmetic and functional rhinoplasty procedures alter the external structure of the nose, which is why the procedures result in a changed appearance.

In septoplasty, only the inner nasal structure (the septum) is altered. External nose cartilage is unaffected by the procedure.

Surgical Technique

Cosmetic and functional rhinoplasty are performed via an open (external) or a closed (endonasal) surgical technique to expose the skeletal framework directly under the nasal skin. The surgeon chooses between the two techniques depending on the best approach to attain the desired end result. You can learn more about open and closed rhinoplasty by reading this blog post.

Septoplasty uses an endonasal technique where all surgical manipulation takes place inside the nose.

Scarring

Cosmetic and functional rhinoplasty procedures performed using an open surgical technique require an external incision in the columella, the area between the nostrils. The skin in this area heals better than any other area of the body, so the scar is usually imperceptible. Even keloid formers heal well from this incision. Rarely, ancillary laser and dermabrasion procedures may be needed to minimize the scar further.

Since septoplasty addresses the inside of the nose the procedure leaves no noticeable external scarring. However, internal scarring can occur, which may compromise the functional results. In complicated septal repairs, surgeons often place internal splints to lessen the risk of internal scarring.

Insurance Coverage

Cosmetic rhinoplasty is not covered by medical insurance as the procedure is classified as a cosmetic (or aesthetic) procedure done only to enhance one’s appearance.

Since the primary goal of both functional rhinoplasty and septoplasty is functional improvement of the nose (breathing enhancement), the procedure may be deemed medically necessary by insurance companies and either partially or fully covered depending on the medical plan. This determination typically depends on the severity of the obstruction as determined by the surgeon. Unfortunately, today’s insurance companies will often deny nasal valve repairs when performed in conjunction with septoplasty. Also, most insurers will not cover any procedure that changes your appearance, deeming it cosmetic, whether this change is required for functional improvement or not. Your surgeon can give you more information about your insurance certification process during your consultation.


Minas Constantinides, MD, FACS

Dr. Minas Constantinides is a board-certified Facial Plastic Surgeon at Westlake Dermatology & Cosmetic Surgery in Austin, Texas. He is on the Executive Committee of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and is a Senior Advisor of the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).


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