A “nose job,” formally known as rhinoplasty, is often associated with cosmetic changes, but the procedure also corrects structural issues that impede breathing. While cosmetic rhinoplasty focuses on external appearance, functional nasal surgery improves the internal architecture of the nose to restore proper airflow. Understanding this difference is the first step in determining if a structural issue causes chronic breathing difficulties. Surgery for purely functional reasons is often considered medically necessary, which affects treatment options and coverage.
Recognizing Symptoms of Impaired Nasal Breathing
A person may suspect a structural breathing issue if they experience persistent nasal congestion not relieved by common medications like decongestants or allergy sprays. This blockage can be constant or alternate between the two nostrils, often indicating an underlying anatomical problem. Difficulty breathing during physical exertion, such as exercising, is another sign that the nasal airway may be compromised. The nose is the primary breathing apparatus, and an inability to use it fully during activity suggests insufficient airflow.
Many people with structural nasal issues resort to persistent mouth breathing, especially at night, which can lead to a dry mouth or sore throat upon waking. This compensatory mechanism occurs when the nasal passages are blocked and the body seeks enough oxygen. Chronic nasal obstruction also contributes to disruptive snoring and can be a factor in obstructive sleep apnea. Poor nasal drainage caused by structural blockages can lead to recurrent sinus infections or facial pressure around the eyes and cheeks.
Underlying Structural Conditions Requiring Correction
The symptoms of chronic nasal obstruction often point to one of three primary anatomical problems that reduce the nasal airway’s cross-sectional area. The first is a deviated nasal septum, which occurs when the thin wall of bone and cartilage separating the two nasal passages is off-center. This common condition can be present from birth or result from an injury, causing a narrowing of one or both sides of the nasal cavity. The displacement of the septum leads to chronic blockage in the narrower passage.
Another common issue is turbinate hypertrophy, the chronic enlargement of the turbinates, which are shelf-like structures inside the nose. Turbinates warm, humidify, and filter inhaled air, but when they swell due to allergies or chronic inflammation, they obstruct airflow. The turbinate opposite a deviated septum may sometimes enlarge as a compensatory response. The third common cause of structural obstruction is nasal valve collapse, involving the weakening of the cartilage supporting the side wall of the nose.
The nasal valve is the narrowest part of the airway. When its cartilage support is weak, the side wall can collapse inward upon deep inhalation, similar to a straw bending under suction. This mechanical failure significantly restricts the amount of air entering the lungs. Identifying which structure is affected is crucial because each requires a different surgical approach for correction.
The Medical Process of Determining Surgical Need
Determining the need for functional nasal surgery begins with a consultation with an ear, nose, and throat specialist or a plastic surgeon specializing in functional rhinoplasty. The physician reviews the patient’s history, focusing on the duration and severity of breathing issues and any prior treatments attempted. A physical examination is performed using a nasal speculum to inspect internal structures for visible signs of a deviated septum or enlarged turbinates.
A simple, informative test often performed is the Cottle Maneuver, where the doctor gently pulls the cheek skin outward away from the nose. If this movement causes an immediate improvement in the ability to inhale, it suggests that nasal valve collapse contributes to the obstruction. Objective diagnostic tools may also be utilized to confirm structural issues.
Diagnostic Tools
A Nasal Endoscopy involves inserting a small, flexible camera into the nasal passage to get a detailed view of the internal structures and assess the degree of obstruction. In some cases, a Computed Tomography (CT) scan may be ordered to provide a detailed image of the bony and cartilaginous anatomy, useful for evaluating the septum and surrounding sinuses. A surgical recommendation is typically made only after non-surgical treatments, such as nasal steroid sprays or antihistamines, have been attempted without providing lasting relief. The decision for surgery is based on confirmed anatomical blockage unresponsive to conservative medical management.
Functional Surgical Interventions for Breathing Improvement
Once a structural cause is confirmed, specific surgical procedures are recommended to restore proper nasal function. Septoplasty corrects a deviated nasal septum by straightening and repositioning the bone and cartilage of the dividing wall. This surgery focuses solely on internal structural correction and typically does not alter the external appearance of the nose. It is one of the most common surgeries performed to address chronic nasal obstruction.
If enlarged turbinates are a cause of the blockage, a Turbinate Reduction procedure may be performed, often with a septoplasty. This procedure reduces the size of the turbinates, which are composed of bone and soft tissue, to open the nasal passageway while preserving their ability to humidify and warm the air. The goal is to maximize airflow without compromising their physiological function.
For cases involving external deformities or nasal valve collapse, a more comprehensive procedure known as Functional Rhinoplasty may be required. This surgery supports the weakened cartilage in the nasal valve area, often using cartilage grafts harvested from the patient’s septum or ear. While the primary goal is the functional improvement of breathing, the necessary structural repairs may sometimes result in a subtle, positive change to the external shape of the nose.