Functional rhinoplasty is surgery in which the appearance of the nose and its breathing function are addressed in the same operation. When a deviated septum is also corrected, the procedure is called septorhinoplasty. As an ENT-trained surgeon I do not see this as a separate kind of rhinoplasty but as part of any properly performed one: the inside of the nose cannot be ignored while the outside is changed.
Structures that obstruct breathing
The main surgically correctable causes of nasal obstruction are:
- Deviated septum: displacement of the central wall that divides the nose into two halves. It narrows the airway and may also be visible externally as a crooked nose.
- Turbinate hypertrophy: enlargement of the fleshy structures inside the nose, usually related to allergy or chronic inflammation.
- Nasal valve narrowing: weakening or collapse of the narrowest passage just behind the nostrils; noticed as the sidewalls being drawn inward on inspiration.
- External nasal deviation: shift of the bony and cartilaginous framework to one side, often after trauma and usually accompanied by septal deviation.
These problems frequently coexist. Correcting only one of them may not relieve the complaint while the others remain.
Who is it suitable for?
Functional rhinoplasty comes up in two groups of patients. The first are those unhappy with the shape of their nose who also have breathing complaints; combining the two goals in one operation spares them a second surgery. The second group have no aesthetic expectation but a breathing problem that originates in the external framework; a crooked bony vault, for example, does not straighten with septoplasty alone and the framework itself must be corrected.
Examination and planning
Assessment begins with finding where the breathing complaint comes from. The septum, turbinates and valve area are examined with an endoscope; when needed, a sinus CT scan images the internal structures and sinuses. Allergy history, previous treatments and the positions in which the complaint worsens are asked about. The external examination assesses the symmetry of the bony vault, cartilage support and the movement of the sidewalls during breathing.
Planning follows these findings: which structures will be corrected, how the aesthetic goals will be reconciled with the functional correction, and whether cartilage grafts will be needed for support are decided in advance. Expectations are discussed openly at this stage.
How is the operation performed?
Septorhinoplasty is performed under general anaesthesia; its duration depends on the extent of the procedures. The operation may include the following steps:
- Septoplasty: the deviated septum is straightened; the cartilage removed can be used as support grafts in the same operation.
- Turbinate reduction: enlarged turbinates are reduced by radiofrequency or surgical means; the tissue is not removed entirely so that it keeps its function.
- Valve support: the narrowed valve area is widened and supported with grafts prepared from septal cartilage.
- Correction of the bony vault: a crooked or humped bony vault is reshaped with osteotomies or the piezo technique.
- Aesthetic corrections: adjustments to the hump, tip and nostrils are performed in the same session.
The operation can be done with the open or closed technique; the choice depends on the location and extent of the structures to be corrected and is made during examination. See the Open vs Closed Rhinoplasty page for details.
After the operation
Whether packing is placed inside the nose depends on the extent of the surgery; today most patients receive silicone splints that allow breathing and are removed within a few days. The external splint stays for about a week. Breathing may fluctuate in the first weeks because of internal swelling and becomes clearer over months as the internal structures settle. Follow-up visits matter during this period.
Why address both goals together?
If the internal structures are left untouched in a purely aesthetic operation, an existing breathing problem persists; in some cases reducing the nose can narrow the airway further. Conversely, if the external framework is ignored in an operation done only for breathing, the deviation remains. The functional approach aims to avoid both situations: the nose is planned as a whole that is in harmony with the face and performs its function.
This page is for general information; diagnosis and treatment decisions are made during examination. Related topics: Septoplasty, Turbinate Treatment, Rhinoplasty: Overview. To arrange an appointment please use the contact page.