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How Functional Rhinoplasty Improves Breathing
Jan 20, 2024

Rhinoplasty, also known as a nose job, is a common cosmetic surgery. According to Harvard Health Publishing, the American Society of Plastic Surgeons finds nearly 220,000 rhinoplasties are performed each year in the United States alone. But did you know some of our patients come to us for a nose job, not because they have an issue with the way their nose looks, but because they need to breathe better?  

When an operation is performed on the nose to address an aesthetic concern, it’s called “cosmetic” rhinoplasty. If the surgery is meant to restore airflow through the nose, it’s called “functional” rhinoplasty. So, yes, you can get a nose job to improve breathing!

Here we explain the differences between functional and cosmetic rhinoplasty and how getting a nose job improves breathing. 

How Does Functional Rhinoplasty Affect Breathing?

Here’s how each part of the nose works and is improved during a nose job for better breathing:

  • Turbinates. The turbinates are three bony structures on the cheek side of each nasal passage, near the bridge of the nose. They work like fins to shape the air currents so they flow smoothly inward toward the septum. Functional rhinoplasty can change the shape of these “fins” to allow air to flow more efficiently.
  • Nasal septum. The septum runs down the middle of the nose. It’s bony at the back of the nose, but near the bridge, it becomes flexible cartilage. We need the nose’s bridge to support the soft tissue of the nostril, much like the center tent pole supports a tent. 

    Air currents usually run down the septum smoothly when it’s straight, allowing it to perform important functions like warming the air entering the body, and filtering dust and bacteria. If the septum is bent or broken by trauma or previous operations, it can disrupt airflow down the nose, sometimes even blocking it completely. If this center is misaligned, it could block airflow to one side, and that’s why functional rhinoplasty is necessary in cases where the septum is deviated.

  • Nasal ala. The alar cartilages form the tip of the nose. They are springy structures with a unique shape that gives you flared nostrils for scenting air, and account for the wide diversity in the shapes of the nasal tip. 

    Alar cartilages function more like the curved poles that spring up to form the entrance to a tent. They aren’t the primary support, but they do have a big effect on controlling airflow. During a functional rhinoplasty, this cartilage can be corrected to let in more air.

We use specific techniques to ensure functional rhinoplasty gives our patients better nasal airflow—the turbinates, the nasal septum, and the alar cartilage are manipulated during surgery to give the best results. Any one of these three structures can block airflow, but generally, the nasal septum and alar cartilages determine the aesthetic shape of the nose and how efficient breathing through the nose can be.

deviated septum

Did You Know?

Rhinoplasty has quite a long history. The first nose operation was reported in 6th century B.C. in India, to replace a missing nose. In ancient times these procedures were performed to repair injuries due to leprosy, syphilis, or trauma. The modern cosmetic rhinoplasty is relatively recent, and the first procedure is generally credited to the otolaryngologist Dr. John Orlando Roe in 1887. Many advancements have been made since. 


What Does Rhinoplasty Surgery Involve?

Rhinoplasty operations might involve modification of all three structures of the nose, depending on the patient and the outcomes desired. 

Functional rhinoplasty often combines access to the turbinates and the nasal septum. The term septoplasty is used to describe a procedure where the surgeon concentrates on the nasal septum. Turbinate modification usually describes a procedure to shave off the turbinates for better airflow.

Cosmetic rhinoplasty often combines interventions on both the nasal septum and the nasal tip. Even if someone wants only to change the shape of their nose bridge, the alar cartilage must often be detached to reach it properly. If a patient just wants to change the shape of the nose tip, its placement is highly dependent on the septum for support.


RELATED: Open vs. Closed Rhinoplasty

Is My Rhinoplasty Considered Cosmetic or Functional?

This is an important question as it affects the cost of a rhinoplasty, but the distinction isn’t always clear-cut. Lots of people are unable to breathe through their noses, and rhinoplasty procedures are highly effective at addressing this. But before undergoing surgery, it’s important to have a clear idea of your goals and options. The best operation for you will depend on your body, your overall health, previous surgeries, and your desired aesthetic and functional outcomes.

For instance, the National Institutes of Health tells us that roughly 10% of people who have a cosmetic rhinoplasty procedure will go on to develop breathing difficulties, often because of improper aftercare. If those patients decide to have a secondary revision procedure, the secondary procedure would be for functional reasons. Seventy percent of the patients who go on to have revision rhinoplasty surgery do so primarily to improve their breathing.

In other cases, someone who has had a broken nose due to trauma might develop breathing difficulties because the septum is crooked. However, choosing to have rhinoplasty to have the septum straightened will usually also have an aesthetic effect, and they might want to have some additional cosmetic work done on the alar cartilage during the procedure. This makes it a combined aesthetic and functional procedure, and sometimes insurance will cover the cosmetic portion of the operative costs.

Does Insurance Cover Rhinoplasty?

Differences between these surgeries will determine whether or not insurance will pay for them. This can confuse patients who want to know if their nose job will be covered—because the structural supports of the nose affect both its form and function, these operations are often interrelated. 

Improve Your Breathing With a Nose Job

New Jersey rhinoplasty surgeons Dr. Gary D. Breslow and Dr. Patrick J. Greaney will be happy to answer all your questions during your first consultation and guide you toward the approach that is most suitable for you.

About the Author

Dr. Gary Breslow, MD, FACS

Dr. Gary Breslow, MD, FACS

Is a highly regarded plastic surgeon in Paramus New Jersey, known by both patients and peers as a problem-solver with a warm, engaging personality, and an instinctive ability to identify and truly understand the goals of his patients and the patients, themselves. Dr. Breslow has dedicated his efforts to providing results of only the most unsurpassed quality, continually staying abreast of the most advanced techniques in cosmetic surgery for the benefit of his patients. Dr. Breslow is Board-Certified by the American Board of Plastic Surgery, is a member of the American Society of Plastic Surgeons, is a Fellow of the American College of Surgeons, and is licensed to practice plastic & reconstructive surgery in both New Jersey and New York.

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