The Importance of Function in Rhinoplasty
While the desired changes to your nasal appearance are what you are most interested in, it’s also very important to remember that maintaining (or in same cases improving) proper nasal function is equally important. It’s hard to enjoy a beautiful nose if you can’t breathe. In fact, the inability to breathe can be quite distressing and can have a significant impact on your quality of life. When you choose a rhinoplasty surgeon, make sure he or she is knowledgeable and experienced in nasal anatomy and function.
Nasal obstruction can be due to many factors. The mucosa (or lining) of the nasal passages may be swollen. In this case, treatment is more medical and directed at reducing the swelling. Sinusitis can also cause nasal obstruction. Otolaryngologists (or ear, nose, & throat surgeons) are experts in diagnosing and offering surgical treatments for those patients that are candidates. Sometimes, an anatomical wide middle turbinate (structure that covers a major drainage path of sinuses) may be present and contribute to nasal obstruction. This is called a concha bullosa. Surgically reducing a conchal bullosa can help.
For a rhinoplasty expert, the focus is on anatomic structures that are important in nasal function. For me, I evaluate the nose in light of four basic structures. First, I evaluate the septum. Next, I assess the internal valves, followed by the external valves, and finally I look at the inferior turbinates (structures along the lower part of your nasal side walls. These are not exclusive, but problems may exist in one or several of these. Other surgeons may have a different framework when evaluating these.
First, the septum is that structure that divides the nose into left and right halves. Ideally, the septum is midline and straight. The reality is not many of us have a perfectly straight septum, but generally the septum is straight enough that patients have equal airways on both sides. But if the septum is significantly deviated to one side, that side will feel more restricted. I try medical management first (using a topical nasal steroid). If that fails, then surgery is offered to straighten a septum (called a septoplasty). Surgery is typically straightforward, and patients will go home only with internal splints that come out a week later.
The nose has two sets of valves—the internal and the external. The internal valve is the area of greatest airway resistance. It is comprised of the upper lateral cartilages (the middle 1/3 of your nose that is a bit mobile), the septum and the face of the inferior turbinate. Textbooks describe an angle of about 10 degree, which if less, results in internal valve collapse. Treatment options for internal valve weakness include using Breathe right strips or surgery to increase the internal nasal valve. There are many surgical techniques to improve the nasal valve; I prefer placing spreader grafts, which are cartilage struts that go between the septum and upper lateral cartilages. These grafts can be taken from your septum, your ear cartilage, or from a donor rib cartilage.
The external nasal valve is basically the most distal portion of your nose—essentially the nostril. Important structures that comprise the external valve include the lower lateral cartilages, the distal end of the septum, and middle structure of the nose (columella). A common finding in someone with external valve collapse is the inward motion of one’s nostril when one breathes in deeply.
Just as in internal valve collapses, there are many surgical options for treating external valve collapse. I prefer either what we call alar batten grafts, or alar strut grafts. Regardless of technique, the goal is to stiffen the external valves so that they don’t collapse as much. Generally, surgery to address the nasal valves will require an open approach—where an incision is made in the columella and the nose opened. Recovery is a bit more prolonged compared to simple septoplasty, and requires a bit more wound care on your part.
Finally, I look at the inferior turbinate’s. If they’re enlarged and don’t decongest, then I recommend some surgical treatment to make them smaller and less reactive. This can be simple heat treatment or as aggressive as surgically debulking the bone and excess mucosa (nasal lining).
As you can see, there are many variables that play role in proper nasal function and you should see a surgeon with expertise in the evaluation and treatment of the nose, in addition to ability to alter the nasal shape that you want. Choosing the right rhinoplasty surgeon is an important decision, and I discussed my ideas of how to choose the best surgeon for you in a prior blog.
It’s also possible your insurance carrier will cover treatments aimed at improving your nasal function. Since every insurance is different, talk with your surgeon’s staff and your carrier to find out if you can file a claim. Remember, insurance will only reimburse the amount they have set for functional repair. While this won’t likely cover the entire rhinoplasty cost, it may decrease the out of pocket costs.
For more information about San Antonio rhinoplasty surgery, please visit our interactive website at www.dryuplasticsurgery.com. Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery is a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please contact our Concierge Patient Coordinator at (210) 876-6868 or info@dryuplasticsurgery.com
