Nasal Surgery: Fixing Form and Function

Cosmetic—Plastic surgery for the nose (called rhinoplasty) has to do with the shape of the nose and how it balances with other features of the face. Because the nose is the most noticeable facial feature, even a slight change can improve appearance. Before surgery, it is very important that the patient have a clear, realistic understanding of what change is possible as well as the limits and risks of the procedure.

Rhinoplasty is an individualized surgery that involves a consultation with a surgeon to discuss the patient’s desired appearance of the nose and a breathing assessment. The patient and his or her surgeon should consider skin type, ethnic background, and age when discussing cosmetic nose surgery. The surgeon will also describe risk factors, which are generally minor, as well as where the surgery will take place—in a hospital, outpatient surgical center, or a certified office operating room. Except in cases of significant breathing impairment or to correct a deformity or injury, young patients generally should not have work on their nose until their facial bones are fully developed, at 15- or 16-years-old.

To reshape the nose, the surgeon makes an internal or external incision and lifts the skin to remove or rearrange the bone and cartilage. The skin is then sutured or stitched to close the incision over the modified bone and cartilage. A temporary nasal splint may be placed on the outside of the nose to help keep the new shape for five to seven days after surgery. If a splint or packing is placed inside the nose to stabilize the septum, it will normally be removed within the next week after surgery.

Chronic Stuffy Nose—Millions of patients suffer from recurring nasal stuffiness or obstruction. Nasal obstruction may be a structural problem inside the nose, or may be due to swelling caused by allergies, chronic sinus inflammation, or other conditions.

A blockage may be caused by a deviated septum (the wall that separates the two sides of the nose), which may be crooked or bent as the result of abnormal growth or injury. This can partially or completely close one or both nasal passages. About 80 percent of people have some degree of septal deviation, but if the deviated septum causes significant nasal or breathing obstruction, it can be corrected with a surgical procedure called septoplasty. Cosmetic or structural changes to the nose can be performed at the same time, in a combination procedure called septorhinoplasty.

Enlargement of the structures inside the nasal passages (called turbinates) is another cause of stuffiness or nasal obstruction. Sometimes the turbinates need treatment to make them smaller and open the nasal passages. Treatments include surgical procedures such as turbinate reduction or partial removal. Allergies can also cause turbinate enlargement and nasal obstruction, and allergy testing and treatment may be a good consideration.

Narrow nostrils or nasal valve collapse can cause the openings of the nose to block airflow. The cartilages that form the support for the nostrils may be pinched or may collapse with breathing in, causing nasal obstruction. External adhesive nasal strips such as those worn by athletes or at night to improve breathing may help. If nasal strips or nasal splints improve breathing through the nostrils, a nasal tip or nasal valve surgery or rhinoplasty may be helpful in improving airflow.

Aging Nose—Aging is a common cause of nasal obstruction. This occurs when cartilage in the nose and its tip are weakened by age and droop because of gravity, causing some collapse of the nostrils, blocking air flow. Mouth-breathing, or noisy and limited breathing, is common.

Try lifting the tip of your nose to see if breathing is better. If so, surgery to adjust or lift the tip of the nose or support the cartilates of the sides of the nose may be helpful. Talk to a facial plastic surgeon or otolaryngologist about nasal tip surgery or rhinoplasty, which may involve trimming and reshaping or supporting of the nasal and septal cartilage. Splints or soft packing may be placed in the nostrils or over the nose to hold the nasal tip or septum in its new position. Usually, patients experience some swelling for a week or two. However, after the packing is removed, most people enjoy much better breathing.