Rhinoplasty is an extremely delicate and technically challenging cosmetic procedure, which can be performed, to correct functional problems or for aesthetic reasons. In many instances these procedures are consolidated into a single operation, reshaping the nose and correcting functional issues at the same time.
Compromised breathing function
Impediments to proper breathing or functional airway obstruction can arise in a number of ways. Birth defects, an accident or injury to the nose or even nasal collapse due to cocaine use are common reasons. Infections, allergies and sinus problems can also lead to breathing problems.
Airway obstructions can manifest in a number of ways including a congested nose, breathing through the mouth—especially in the night, a reduced sense of smell or dry mouth. People suffering from chronic nasal obstruction may experience nosebleeds, sinus pressure headaches and recurring sinus infections. Dysfunction of the Eustachian tube, which links the middle ear to the back of the nose and upper throat and equalises the air pressure on the two sides of the ear drum, can cause discomfort and hearing problems. Blocked airways can cause sleep disturbance. Untreated nasal obstructions and the resulting chronic nasal dysfunction may lead to insomnia, obstructive sleep apnoea, hypertension and heart disease.
Form and function of the nose are intricately linked
When performing cosmetic rhinoplasty the surgeon has to ensure that breathing function is not compromised.
Certain functional problems, such as a deviated septum, enlargement of nasal turbinates and nasal polyps, are confined to internal nasal passages. They can be treated without affecting or changing the outer nose structure and appearance. But correcting other functional issues like, for example, nasal valve collapse necessitates changing the external framework of the nose.
To understand what these different procedures are and what they entail, read on.
Straightening a deviated septum
The septum of the nose is the bone and cartilage wall that divides the right and left sides of the nose. We say a septum is deviated when it is off-centre or crooked, making it difficult to breathe.
Most people have some imbalance in the two sides of their nose. If the imbalance is minor it often goes unnoticed. Only severely deviated nasal septa cause breathing problems and need treatment. Birth defects, injury or trauma to the nose can be the cause for a severely deviated septum.
The most common symptom of a deviated septum is nasal congestion. A deviated septum can lead to recurring sinus infections, frequent nosebleeds, headaches, facial pain and postnasal drip. Loud breathing and snoring can also be caused by a deviated septum can lead to a more serious condition, obstructive sleep apnoea.
Nasal septoplasty is the procedure that corrects the imbalances between the two sides of the nose. Recovery from this procedure is easy, simple and quick.
It is sometimes possible to relieve the symptoms of a deviated septum with medications such as nasal steroid sprays. However, this will only provide short-term relief. If medication does not provide relief, nasal surgery is the next option.
The internal nasal cavity contains three mucus-covered bony protrusions called turbinates. They are located on the outer wall of each nasal passage and help warm up, filter and moisten the air we breathe in. It’s like the body’s own humidifier.
The inferior turbinate is the largest and the lowest of the three. An enlarged inferior turbinate is a common cause of nasal obstruction. Turbinate reduction is a straightforward surgical procedure and recovery is usually quick and painless.
Removing nasal polyps
Nasal polyps are noncancerous teardrop or grape-like soft growths that develop in the lining of the nasal cavity and sinuses. They cause no pain. Small nasal polyps often cause no symptoms, but larger ones can block the nasal passages, causing breathing problems, infections and, sometimes, loss of the sense of smell.
In mild cases removing nasal polyps is a straightforward procedure, but they often recur. Aggressive allergy treatment, especially for fungal allergies, can often help reduce risk of recurrence.
Surgery involving the external framework of the nose
Correcting severe forms of breathing obstructions may require surgery that involves the external nasal framework. In patients with deviated, twisted, pinched or collapsed septa, surgery of the internal airways will not be enough. Correcting these issues often requires nasal reshaping to straighten, enlarge and reinforce nasal passages.
Nasal valve collapse is the most common cause of external nasal airway blockages. The nasal valve typically remains open when we breathe normally and will collapse with heavy breathing associated with exercise.
People who have thin noses or whose noses have been altered by disease, ageing, nasal injury or some type of nose surgery may experience nasal valve collapse. Over time, surgeons have developed many sophisticated rhinoplasty techniques for treating this condition. However, there is no single technique that works universally. Treatment for nasal valve collapse has to be tailored for each individual.
Often a patient may request a thin and slender nose, opening up the possibility of nasal valve collapse. In such cases Dr Marcells has to “strike a balance between aesthetics and potential harm to the patient. The scale will always be tipped more towards healthy breathing function than towards aesthetics”.
The ability to strike a healthy balance and prevent nasal valve collapse following cosmetic rhinoplasty that separates masters of rhinoplasty like Dr Marcells from other surgeons.
For more information
Check out our previous post, Your First Rhinoplasty Consultation, for an idea about what happens on your first visit.
You may also want to check out the Nose Gallery on this website to get an idea of the wide range of nose surgery performed by Dr Marcells.
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Meet Dr Marcells
MBBS (Syd), FRACS (ORL-HNS)
Past President – Australasian Academy of Facial Plastic Surgeons
Dr George Marcells is known for excellence in facial plastic surgery and is considered a true master of rhinoplasty. He performs advanced surgical techniques to restore balance and harmony to the face and can also resolve functional issues such as breathing difficulties.