While this may be performed for purely cosmetic reasons to improve appearance, often the primary or simultaneous goal is to restore the ability to breathe through the nose.
In this case, the surgery is more specifically referred to as a functional rhinoplasty. A functional rhinoplasty typically involves repair of the nasal valves, which is the medical term for the internal cartilage valves within the nostrils. These can be congenitally narrow (meaning you are born that way), collapse with age, or can be scarred from prior surgery. While surgery on the nasal valves is usually performed to restore breathing, it typically necessitates some type of change to the appearance of the nose.
Indications of the need for a functional rhinoplasty include, but are not limited to:
A functional rhinoplasty may be performed under different types of anesthesia depending on patient and physician preference, including local anesthesia (i.e. patient awake but with “numbing medications”), intravenous sedation (i.e. “twilight”) or general anesthesia (i.e. completely asleep). Incisions are made to allow access to the underlying cartilage and bone. These incisions may be hidden completely inside the nostrils, or involve internal incisions combined with a tiny incision through the skin at the base of the nose.
Often cartilage and/or bone may need to be obtained from another site to help gain support. These cartilage grafts are often taken from the nasal septum during the portion of the procedure, although sometimes ear or even rib cartilage may need to be harvested. Further reshaping or grafting may need to be performed with sutures to the cartilage, or sutures to reshape or suspend the cartilage. – or deliberate fracturing of the nasal bones – may be performed to straighten the nasal bones if they are crooked or deformed. Although cartilage grafting remains the most common type of functional rhinoplasty, procedures to reshape the nostrils (ex: a “z-”) or the use of sutures and screws to suspend the nasal tissues have grown in popularity.
At the conclusion of the procedure, the outside of the nose is often taped and some form of external cast may be applied. Plastic sheets and/or packing may also be temporarily placed inside the nose depending on the procedure and the surgeon’s preference.
Studies have shown that most functional heal without serious problems or complications and the majority of patients are able to breathe better and enjoy an improved quality of life. However, there are potential complications that every surgical candidate should be aware of before proceeding with the procedure which include (but are not limited to):
An improvement in nasal airflow is the primary benefit of a rhinoplasty performed for functional reasons. The procedure may also straighten the nose, repair post-traumatic or congenital deformities, and improve the appearance.