Can nose surgery improve my breathing without changing my look?

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.

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.