Functional rhinoplasty is a surgical procedure that is performed to correct various breathing constriction issues, with a secondary goal of enhancing the overall appearance of the nose.
Functional rhinoplasty techniques repair the nasal valves (the internal cartilage valves within the nostrils that regulate air flow) in order to restore proper breathing. The nasal valves can be congenitally narrow (from birth) or can collapse due to normal aging, injury or previous cosmetic rhinoplasty surgery. Functional rhinoplasty restores the nasal passageways to allow for normal functionality. While surgery on the nasal valves is usually performed to restore breathing, it can also change the appearance of the nose.
Unlike traditional rhinoplasty, which is solely performed for cosmetic reasons, functional rhinoplasty procedures (such as septoplasty, nasal facture correction, nasal valve repair, and turbinate reduction surgery) are often medically necessary. As such, many medical insurance providers view the procedure as reconstructive and may cover all or a portion of the procedure’s costs.
A deviated septum is a narrowing of the nasal passage that can make breathing difficult. A deviated septum is caused by the cartilage and/or bone in the area between the nostrils being crooked or off-center.
Depending on the degree of misalignment, a deviated septum can range from being a minor inconvenience to severe enough to cause major breathing problems. In fact, it is estimated that nearly 80% of all people have some degree of misalignment, though most are not even aware of it.
In order to correct a deviated septum, a surgical procedure called a septoplasty is performed. This procedure repositions and/or removes bone and cartilage from the space between the nostrils to correct misalignment and restore breathing. During a septoplasty, your surgeon will attempt to straighten the cartilage and bone that have led to the deviation of the septum. Depending on the extent of the procedure, internal splints or (rarely) soft packing material may need to be inserted into the nose to stabilize the septum as it heals.
Nasal Fracture (broken nose)
A nasal fracture (i.e., broken nose) is a crack in the bone over the bridge of your nose, usually caused by some form of facial trauma. Broken noses can result in serious pain, swelling, or bruising under the eyes – much of which can resolve on its own.
However, severe nose fractures can result in long-term misalignment of the nose. The nose can have a severely crooked appearance and obstruct normal breathing. If the break is severe enough to affect your nasal septum, reconstructive surgery may be required to correct both appearance and functionality. During the procedure the fractured bones are realigned to a straighter appearance and reshaped as necessary.
Depending on the specifics of the injury, an open or closed rhinoplasty technique can be used to correct a broken nose. This surgery is typically done on an outpatient basis, with patients fully recovering in as little as a week.
Nasal Valve Repair
Nasal valves are internal cartilage valves within the nostril that serve to control air flow. During high exertion the nasal valves are designed to constrict, reducing the amount of air flowing through the nose. In this way the nose can continue to warm, humidify and filter the inspired air before it arrives into the lungs. Normal aging,injury and surgery can cause nasal valve collapse: when the nasal valves become weakened or narrowed to a point where airflow becomes partially or completely blocked. A collapsed nasal valve causes individuals to experience moderate to severe breathing issues and sometimes can disturb nighttime breathing and sleep.
The Latera Nasal Implant can also be used to help support and open the internal nasal valve, further strengthening this area in the right patient. For more information about the Latera implant, please see our blog post.
Functional rhinoplasty performed with or without the use of grafts or implants can be utilized to repair nasal valve collapse. Depending on the severity of the collapse, cartilage implants may be fashioned from the septum, ears or even ribs.
Turbinate Reduction Surgery
The inferior turbinate (or nasal concha) is a curled bony shelf that protrudes into the breathing passage of the nose. Inferior turbinates are responsible for a variety of normal nasal functionality including warming, humidfying and filtering air, and regulating nasal pressure.. However if the inferior turbinate is overly large it can cause chronic congestion, sinus pressure, headaches, sleep apnea, and nasal obstruction. Enlarged inferior turbinates can be controlled medically, with oral antihistamines or topical nasal steroid sprays (such as Nasacort or Flonase), or surgically.
Turbinate reduction surgery is a procedure to either shrink or remove portions of the inferior turbinate in order to open the breathing airway. In many instances, turbinate surgery and septoplasty are performed at the same time.
Cleft Lip Nose Surgery
Perhaps the most challenging type of functional rhinoplasty deals with the cleft lip nose. The incidence of cleft lip in the general population is about 1:800 live births. Typically cleft lip surgery is performed in youth to close the lip and improve nasal contour. However, invariably either the lip scar, the nose, or both do not mature well and require further correction later in life. The nose also often is obstructed due to septal deviations that occur because of the cleft. In order to insure the best results, the nose has to have stopped growing before this definitive surgery. The youngest age in girls is typically about 15 years old, and in boys around 16 years old. No age is too old for cleft lip nose revision surgery.
Mohs Defects of the Nose
Skin cancer can grow either slowly or quickly, and if they occur on the nose increase the chance that after Mohs surgery either the nose will be distorted because of scars or become obstructed because of new weaknesses due to healing. Fortunately, most nasal Mohs defects can be effectively controlled at the time of closure. For those that do not heal well and leave visible scars or create new nasal obstruction, functional rhinoplasty techniques can help resolve these problems. Cartilage is sometimes needed from the nasal septum, ears or rib in order to create the best functional and aesthetic result in these patients.