Will a rhinoplasty cure, or help, chronic sinusitis? I cannot breathe well.

Question

For cosmetic reasons and medical reasons, I would enjoy a rhinoplasty. I have chronic, horrible sinusitis. My nose has been "stuffy" over a year, maybe even a couple, and seems pretty permanent, uncurable by Fluticasone from my GP. I would consider my 'bridge' of my nose pretty skinny. Would a rhinoplasty help me breathe more comfortably? Would I also be able to talk insurance into helping me pay if it's for a medical benefit? i would also love to remove the extra cartialge bump on the front.

Steven M. Denenberg, MD · Answer

... Many people have chronically "stuffy" noses, but they don't have what we call real sinusitis. If the problem is in the nose itself, it might be treatable at the same time as working on the appearance of the nose. The rhinoplasty surgeon would have to look inside the nose to make that determination.As far as the appearance of your nose goes, you seem to have prominent tip cartilages. But really, the photos you posted don't show your nose in enough detail to give a good idea of exactly what's going on.Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon. You should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe.
I usually make computer morphs when I'm answering questions like this, to show the changes that are possible for a nose with a rhinoplasty, but as I mentioned the photos you submitted aren't good enough for making morphs. At the *very* bottom of the "Learn more" page is a link to instructions on taking and sending photos that are comprehensive and useful for an online consultation like this, in case you'd like a more complete evaluation.

William Numa, MD, FACS · Answer

As others have mentioned, if there is a deviated septum obstructing breathing and/or sinus disease, then surgery of either or both of these conditions can be covered under insurance (less any deductibles or copays you have negotiated with your carrier). Any external modifications of the nose to alter the appearance are considered non-medically necessary, or cosmetic, and are not covered by insurance. It is also important to note that any underlying allergies will not be addressed by surgery and should be discussed separately with an allergist.

Kenneth Yu, MD · Answer

Hello.  If you have functional obstruction due to deviated septum or collapsed nasal valves, a functional rhinoplasty will help you breathe better and there may be a chance your sinus problems decrease.  Generally, however, classic chronic sinusitis is best addressed with functional sinus surgery.  Most insurances will cover functional rhinoplasties, but any cosmetic work will be your responsibility.  The best thing to do if you're seriously thinking of this is to see a board certified facial plastic surgeon.  Some board certified plastic surgeons also have experience with nasal function.  To address the sinus complaints, you should see a board certified otolaryngologist (or ear nose and throat surgeon), or rhinologist.  In my opinion, the best outcome will be achieved by seeing a facial plastic surgeon for your nose and a rhinologist or ENT for your sinus.  Take care.

Michael L. Schwartz, MD · Answer

Rhinoplasty is not a sinus therapy. Sinusitis is a complex problem that often involves many factors such as allergy. Nasal breathing blockage frequently accompanies sinusitis and if caused by problems such as deviated septum can be corrected at the time of rhinoplasty. Some sinus problems do require surgical intervention and these also can be performed at the time of rhinoplasty.Rhinoplasty however is a cosmetic procedure that results in a permanent change of your facial appearance. If this is not what you are seeking and will make you happy do not talk yourself into it because of sinus issues.

Michael R. Menachof, MD · Answer

A rhinoplasty, done for cosmetic reasons, will not help with chronic sinusitis and will not always help improve her breathing.  Surgery specifically done for these problems include surgery to open up the obstructed sinus openings, surgery to straighten the septum, and usually surgery to reduce the size of the inferior turbinates. A cosmetic rhinoplasty does not necessarily include any of these procedures.  With that said, all of these procedures could be done with a cosmetic rhinoplasty and because the insurance is paying for the non-cosmetic issues, your total price is sometimes less. Make an appointment to see a well respected, experienced rhinoplasty surgeon who also does a lot of functional nasal surgery.  This would be a good place to start.  Good luck.

William Portuese, MD · Answer

It's best to seek out a consultation by a double board certified ENT/facial plastic surgeon, to sort out all the issues that you're having internally with your nose. There are a variety of  issues that can cause nasal obstruction, such as a deviated septum, turbinate hypertrophy, allergies and chronic sinusitis. Each one of these issues are treated differently with medications or surgery. Chronic sinusitis has to be documented with a CT scan of the sinuses. When polyps are present, functional endoscopic sinus surgery is performed to remove them. Functional nasal surgery such as a septoplasty and sinus surgery can be performed simultaneously with a cosmetic rhinoplasty. Expect to pay for the cosmetic rhinoplasty can yourself. Anticipate co-pays and deductibles associated with your medical insurance for the functional component. Functional nasal surgery can only be performed once medical necessity has been documented and pre-authorization with your medical insurance has occurred. For more information about both functional and cosmetic nasal surgery, please see the link and the video below

Sachin S. Pawar, MD · Answer

In general, you can have breathing difficulties through your nose for one or a combination of two reasons: 1) inflammation/swelling of the lining tissues of your nose (i.e. chronic sinusitis or rhinitis) or 2) structural or anatomic airway obstruction. Chronic sinusitis or rhinitis is a “medical” problem, meaning that these are typically best treated with medications such as the nasal steroid that you are on, or in some cases, topical or oral antihistamines and possibly even a steroid sinus rinse. For some patients who do don’t respond to typical medications, there may be a role for sinus surgery to help open the natural drainage pathways and facilitate medication getting to where it needs to go. On the other hand, structural issues such as a deviated nasal septum or nasal valve collapse will not respond to medications and typically require surgery such a septoplasty, rhinoplasty, or nasal valve repair to correct.Patients can have either one or both of these issues contributing to nasal obstruction and the management can vary depending on the degree and severity. In most cases, both sinus surgery and functional nasal airway surgery to correct any structural problems will be covered by insurance. However, if you have additional cosmetic concerns that could be addressed at the same time through a cosmetic rhinoplasty, this would typically be an additional out of pocket expense.I would encourage you to seek out a consultation with a board-certified ENT or ENT/facial plastic surgeon who can better evaluate you and determine your best treatment options. Good luck!

Benjamin C. Paul, MD · Answer

Thanks for posting your questions. Insurance will pay if you cannot breathe through your nose (due to a deviated septum, turbinate hypertrophy, valve collapse, mass...) or have chronic sinusitis (swelling, infection, pressure of the sinuses (between, under and above the eyes). There are many reasons one cannot breathe through your nose, and a qualified surgeon (ideally with ENT and facial plastics background) should evaluate you. In general, the best treatment for chronic sinusitis is sinus surgery - not rhinoplasty. Best of luck!

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