Functional Considerations

This is an example of a severe septal deviation that can be easily seen from the base view. Typically, septal deviations are not seen this easily. Bringing the septum back to the midline is necessary to improve breathing and will help straighten a crooked nose.

Many patients consider undergoing rhinoplasty for purely cosmetic reasons, but it is vitally important for them to understand that these external changes can impact nasal breathing and function. While in the past, rhinoplasty surgeons paid little attention to this cause-and-effect relationship, the experienced rhinoplasty surgeon optimizes the airway in concert with the nasal contour.

It is well known that the dynamics of breathing can be affected by a weakened nasal structure. One example is the external nasal valve (over the nostrils), which collapses easily on inspiration in patients with congenitally weak cartilage or following overzealous removal of cartilage during prior nasal surgery. It is easy to now understand why previous rhinoplasty techniques led to so many patients who could no longer breathe through their nose. The ‘cookie-cutter’ rhinoplasty of the past involved removal of a large amount of bone and cartilage and osteotomies, but almost no surgical maneuvers or grafting done to stabilize the nose and ensure nasal airway patency.

I always consider the internal nasal structure in every rhinoplasty that I perform. It is always my goal to either maintain nasal breathing, or in some cases, to improve it. Many patients who come see me for a consultation have problems breathing, often due to previous nasal trauma. This can sometimes be seen externally as a ‘crooked nose’ or collapsed nostrils. In cases such as this, it is easy to see why aesthetic changes to the nose are directly related to function.

Asymmetry of the nostrils is sometimes seen in patients with a deviated septum. Note that post-operatively, there is improved nostril symmetry and a more stable nasal structure. This case is an example of rhinoplasty improving both cosmetic appearance and nasal function.

Home Page

Meet Dr. Greene

Our Services

Contact Us