Fast facts

Rhinoplasty


What it is: A plastic surgery procedure to improve the appearance, proportions and structural functionality of the nose.  Rhinoplasty, commonly called a nose job, can enhance facial symmetry and harmony to improve the patient's self-confidence.  Breathing can also be improved as a result.


What it addresses: Specific aspects of the nose, such as:

- Nose size
- Nose width
- Asymmetry
- Nostrils


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Question

Can nose surgery improve my breathing without changing my look?

I have breathing problems because I have kind of a flat nose and was told that rhinoplasty surgery can correct this.  But I am afraid that if I have surgery it is going to make me look a lot different, like Michael Jackson or something.  Is it possible for me to have my breathing problem fixed without ending up like the King of Pop post-Thriller?


Asked by: Keisha, from Minneapolis, MN

Answers (3)

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1
June 20, 2008
William A. Portuese, MD
William A. Portuese, MD
Board Certified
Facial Plastic Surgeon

Yes.  A septoplasty and turbinate surgery can improve breathing out of the nose without altering its appearance.  Changing the look of the nose is cosmetic in nature, and is defined as a rhinoplasty.  A septoplasty and turbinate surgery is of medical necessity and is generally covered through a patient’s medical insurance.

2
February 27, 2008

Functional Rhinoplasty

Functional rhinoplasty is a term that I use to describe a rhinoplasty performed specifically to improve nasal breathing. In many cases, this can be combined with an aesthetic rhinoplasty. In fact, every aesthetic rhinoplasty should be approached with function in mind, and every functional rhinoplasty should be approached with aesthetics in mind.

The short answer to your question is yes, we can improve the nasal airway while maintaining nasal aesthetics. However, much of this will depend on your anatomy. While many think such matters are as simple as doing a ‘septoplasty’, often the issues are more complicated. Seeing an experienced rhinoplasty surgeon will help ensure you get a complete evaluation.

One question to be answered by your physician is: Is there a nasal anatomical issue that affects you nasal airway that is associated with the external structure of the nose?

One example of this is severe anterior septal deviation, for which I have devised a technique called Anterior Septal Reconstruction. In this procedure, the septum is reconstructed via an external rhinoplasty approach and nasal form is preserved.

A second example: narrowing of the midvault area, or ‘internal valve narrowing’. This is tougher to diagnose, but an experienced facial plastic surgeon or otolaryngologist can reliably diagnose this. This can occur after removal of a ‘bump’ on the top of the nose. The classic way to correct this is a ‘spreader graft’ on the affected side(s). This may subtly widen the middle portion of the nose. Other procedures exist to correct this as well.

A third example is called ‘external valve collapse’ and this is sometimes visible as a nostril collapsing. Unfortunately, this can also can happen after aggressive rhinoplasty. I have been asked to correct a number of such cases, and there are a variety of techniques available for this.

Finally, you should be honest with yourself and your surgeon about what your priorities are. If you want minimal to no change, say so. If your breathing is so bad that you would tolerate some more changes, say so.

Here’s little about my philosophy. My goals with any rhinoplasty are:

  • To perform a safe, effective procedure
  • To create a natural, harmonious appearance to the face
  • To maintain or improve the ability to breathe through the nose

I have published numerous articles and chapters on the techniques and outcomes of aesthetic and functional rhinoplasty, and have been asked to lecture nationally and internationally on this topic.

Obviously, rhinoplasty is something I care much about. I spend considerable time with my patients discussing the issues of aesthetics and nasal function, and I think modern rhinoplasty should take both functional and aesthetic considerations into account. Make sure your surgeon understands these issues as well.

3
February 22, 2008

Breathing and Rhinoplasty

Unfortunately everyone fears looking unnatural. This is up to your surgeon's aesthetic understanding, ethics, and experience in rhinoplasty.

As you may already know, rhinoplasty is the most challenging and meticulous procedure performed by Plastic Surgeons. This is why you see so many "bad noses" out in public. You cannot hide or camouflage a bad nose job. Also, it is much harder to correct a nose after a rhinoplasty to improve breathing. The best shot at it is the first time.

It is very possible and is always the foremost goal of my practice to improve nasal features and not only not affect breathing but to improve it. When someone wants ONLY their breathing improved then the goal is just that.

Having said that, depending on the type of nose and what causes the breathing problem, anatomically, sometimes a SUBTLE change in appearance may be produced. I always discuss this with my patients during the consultation. A change in appearance is many times not produced. It all depends on the the anatomy.

For example:

If the nasal blockage is in the internal valves (inside the nose) then a spreader graft may be needed to open up the angle and passage way. This may slightly widen the middle third of the nose but usually not enough for someone to notice (once the swelling is gone!). However, if the blockage is only on one side, then only one side gets straightened and may become a little wider.

Breathing problems that are only a result of a deviated septum can be corrected without changing any of the noses appearance. If the deviation causes a twist in the nose, then obviously the nose will look different when it is straightened, but for the better.

More often than not, patients want some change in appearance at the same time while we are working on the breathing. There are too many variations to discuss here. However, your surgeon will be able to tell you if your breathing problem will have any effect on the appearance. For the most part, it is only small changes that may not even be noticeable or ZERO change at all. Only a detailed exam will tell you.

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