Risk of Empty Nose Syndrome from Rhinoplasty with Turbinectomy?

Question

Just had a Rhinoplasty along with turbinectomy (reduction of both tubinates). When I originally presented, I was simply wanting to improve my aesthetics. He immediately pointed out my enlarged turbinate and said he'd "take care of those" too.During my recovery, I stumbled upon the iatrogenic condition called Empty Nose Syndrome (ENS). It sounds HORRIBLE & dibilitating! I'm now terrified wondering if I'll develop it too. Is there any probability stats out there? Anything I can do at this point?

Richard H. Tholen, MD, FACS · Answer

Patients who undergo aesthetic rhinoplasty want their noses to look better. . .what they do NOT want is to trade a better-looking nose for one that now breathes poorly, or even differently. Many patients have noses that have airway or breathing problems that have been present for so long, they become "mouth breathers," "sinus sufferers," or just get used to partial blockages on one side or the other. Thus, any well-trained, experienced rhinoplasty surgeon needs to take into account not only the appearance changes desired by the prospective patient, but also the condition, position, and dimensions of the septum, turbinates, and each airway!

	During cosmetic rhinoplasty consultations, I explain that each of us has three or four turbinates per side, their function to heat and humidify the inspired air, and how patients with septal deformity or displacement (by development and growth, or by trauma--often as a child) can have a blocked or partially blocked airway on one side, and compensatory turbinate hypertrophy (enlargement) on the opposite side. This is because more air flows on the "open" side, thus stimulating the mucous membranes covering the turbinates on that side to enlarge (hypertrophy) to better heat and humidify the increased airflow on that side. Thus, the nose actually develops a different type of blockage on the (otherwise open) side. Simply repositioning the septum won't work, as the airways are still unequal and turbinate mucous membrane hypertrophy will "compensate" again. Only septal repositioning (centering), septoplasty (as needed), and conservative and appropriate (partial inferior) turbinectomies or turbinoplasty to reestablish equal and normal-sized airways will prevent this see-saw airway problem.

	And if you were unaware of airway issues prior to the cosmetic changes in your nose, you certainly don't want them "uncovered" by failing to address the airways at the time of cosmetic nasal surgery. I do this routinely with every rhinoplasty, and have performed partial inferior turbinectomies in patients who need them for the past 23 years! I have not had one patient that I am aware of complain of ENS after this approach.  I have also re-operated on many patients who have had "breathing operations" elsewhere that have failed more than once, only to have this approach permanently restore a normal functional airway without ENS. I explain this to every patient during their consultation.

	This patient "stumbled upon" empty nose syndrome (ENS) not by experiencing it, but by reading about it on the internet one week after surgery and becoming worried! If you have researched your surgeon's credentials thoroughly and asked questions during your consultation, you should be reassured that you did not have excessive turbinate resection (there are still 3 1/2 turbinates per side!) and will not experience ENS.

	I know this to be a fact since I am your surgeon.

Paul S. Nassif, MD · Answer

Make sure you research your surgeon thoroughly, I can not stress this enough. You want to go with a surgeon who's operative plan involves a conservative Turbinoplasty.

Otto Joseph Placik, MD · Answer

This is not a particularly accepted diagnosis and seems to be soemthing concocted by an individual rather than a true disease entity recognized by the medicl society. I reviewed the website and they seemn to be confusing it with a condition called rhinitis sicca.

Richard W. Fleming, MD (retired) · Answer

We frequently reduce the size of turbinates during rhinoplasty surgery to improve nasal breathing. If you have gone to an experienced, board certified surgeon you do not have to worry about excessive removal of these structures.

Risk of Empty Nose Syndrome from Rhinoplasty with Turbinectomy?

Answers (4)

Answer: Turbinate Reduction

Answer: Turbinate Reduction

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Risk of Empty Nose Syndrome from Rhinoplasty with Turbinectomy?

Answers (4)

Answer: Turbinate Reduction

Answer: Turbinate Reduction

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Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.