Functional Rhinoplasty

Functional Rhinoplasty is surgery to reconstruct the nose just like cosmetic rhinoplasty, but for reasons of nasal blockage. Patients who have had trauma or congenital deformities of the nose and/or septum are candidates for functional rhinoplasty in order to restore proper breathing through the nose both during the day as well as night. Patients with sleep apnea who are unable to wear their CPAP mask due to nasal blockage are also common candidates in order to tolerate their CPAP better. The techniques used in functional rhinoplasty are not much different, so the risks and recovery are essentially the same. Maintaining proper esthetic and ethnic qualities of the nose are very important as well even though it is not considered a cosmetic type surgery.

Rhinoplasty surgery is a common surgery for patients whose nose is either not breathing normally or simply is not cosmetically pleasing to the patient. This discussion addresses those patients who simply want to breathe better (functional rhinoplasty) and are not necessarily interested in surgery for cosmetic reasons.

The most common complaint is nasal blockage or stuffiness, and this may be intermittent or constant. Since underlying medical conditions can cause this, Dr. Speyer will evaluate you for any underlying medical cause (such as allergies or sinus problems) as well as structural disorders such as deviated nasal septum, turbinate hypertrophy in addition to acquired and congenital nasal deformities. Late affects from trauma in the past and the affect of aging can cause progressive nasal blockage that need surgery to correct. People with underlying sleep apnea commonly need nasal surgery in order to be compliant with the use of their CPAP mask.

What most patients and even insurance companies do not realize is that whether a patient desires better function or better appearance, the surgery is very much the same in terms of surgical techniques and recovery. Dr. Speyer’s approach is first to understand what the patient’s complaints are exactly, correlate this with the exam, and then formulate a surgical plan that not only addresses the patient’s specific concerns and needs but also strives to have a balanced aesthetic appearance that fits the patient’s facial features. Each patient is different and there is no surgery that fixes everyone’s problems.

Frequently Asked Questions

What is the difference between septoplasty and rhinoplasty?

Septoplasty is surgery to correct septal deformities only. Rhinoplasty is surgery of the external nasal structures (what you can see in the mirror). The nasal septum is the internal middle wall of the nose that separates right from left, and it is made of both bone and cartilage. Septoplasty is very commonly combined with rhinoplasty to address all of the structural problems (septorhinoplasty).

If I am happy with my appearance, will functional rhinoplasty change my appearance?

Subtle changes in outward appearance of the nose are expected for all rhinoplasty cases. Although the intention is not be overtly change the shape of a nose, surgery will have an effect. Dr. Speyer will explain just what changes are to be expected and whether these will be easily noticeable or subtle. The more severe the problems, the more likely the nose will change post operative. Again, Dr. Speyer’s philosophy is to maintain a balanced result. The goal is to have a nose that appears natural, not post surgical such as a ski slope or overly upturned or pinched nose.

What to expect during my visit?

The initial visit will be used to take your history and perform a complete head and neck exam which may involve nasal endoscopy (exam of the internal portions of the nose). Additional tests may be required such as allergy tests, CT scan of your sinuses, or even sleep studies if not already performed. Photographs are taken of patients contemplating surgery. If you have specific cosmetic concerns you will have to bring this Dr. Speyer’s attention as well. A follow-up visit will be scheduled to review any tests or response to prescribed medical treatment regimens.

What to expect during recovery after functional rhinoplasty?

After surgery internal and external splints remain for about a week and are removed in the office. Bruising and swelling are dependent on the specific surgical maneuvers performed and are usually limited to the first couple of weeks after surgery. Most patients do not require formal packing. Patients should prepare for 7-10 days off of work/school. During the first 6 weeks the initial phase of healing are complete, but your progress will be monitored for at least 12 months.

What if I have had nasal surgery in the past?

If you have already had surgery (whether it be cosmetic or not) bring all pertinent medical records with you so Dr. Speyer can review them. Revision surgery is more complicated in most cases, but this does not exclude you from being a candidate. Even for primary surgeries, patients should know that revisions are not rare but are expected in up to 10-20 percent of cases.

How old do I have to be to have functional rhinoplasty?

Most surgeons generally agree that women should wait until age 17, and men age 18 in order to avoid disturbing the normal growth of the nose until maturity. There is no age cut off per se, but as we all grow older our noses do change and potential medical conditions may make surgery too risky for the older patient.

Will Insurance Cover Nasal Surgery?

Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, major deformity, or injury is frequently covered in whole or in part. Patients should obtain cost information from their surgeons and discuss with their insurance carrier prior to surgery.

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