Nasal Airway Surgery: Addressing Breathing Difficulties Through Functional Rhinoplasty

By Dr Scott J Turner, Specialist Plastic Surgeon (FRACS) – Sydney & Brisbane

Many patients who enquire about nasal surgery at FacePlus Aesthetics discover that their concerns extend beyond appearance. Difficulty breathing through the nose affects sleep quality, exercise capacity, and daily comfort in ways that medications and sprays simply cannot resolve when the underlying cause is structural rather than inflammatory.

Functional rhinoplasty represents a surgical approach designed to address anatomical obstructions within the nasal passages. When combined with aesthetic refinements in a procedure termed septorhinoplasty, patients may achieve both improved nasal breathing and a nose that complements their facial features—addressing two concerns through a single surgical intervention.

Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) who performs functional rhinoplasty at accredited hospital facilities in Sydney and Brisbane. His approach prioritises thorough assessment to distinguish between structural and non-structural causes of nasal obstruction before recommending surgical intervention.

When Anatomy—Not Allergies—Blocks Your Breathing

Not every patient experiencing nasal congestion requires surgery. Structural causes of nasal obstruction tend to produce symptoms that remain constant regardless of season or environment. Unlike allergies that fluctuate with pollen counts or respond to antihistamines, anatomical blockages persist because they involve the physical framework of the nose itself.

Patients whose nasal obstruction may have a structural component often report persistent difficulty breathing through one or both nostrils that fails to improve with medications, allergy treatments, or nasal sprays. Sleep-related symptoms, including snoring, waking with a dry mouth, or feeling unrested, may indicate nasal airway compromise. Exercise intolerance requiring mouth breathing suggests the nasal passages cannot accommodate increased respiratory demands. Some patients notice visible collapse of the nostril walls during deep inhalation—a finding that often indicates weakness in the external nasal valve structures.

A history of nasal trauma or previous nasal surgery may contribute to structural changes that progressively impair breathing. During consultation at Dr Turner’s Sydney or Brisbane clinics, a comprehensive assessment helps determine whether structural abnormalities contribute to your symptoms.

Anatomical Factors Contributing to Nasal Obstruction

Understanding the specific structural abnormalities that impair nasal breathing helps patients appreciate why certain surgical techniques are employed and why conservative treatments alone may prove inadequate.

Septal Deviation

The nasal septum—the partition of cartilage and bone dividing the nasal cavity—rarely sits perfectly in the midline. When deviation becomes significant, one or both nasal passages may become obstructed. Septal deviation may be present from birth, develop during facial growth, or result from trauma at any age. The degree of deviation does not always correlate with symptom severity; the internal dimensions of the nasal passages and specific location of the deviation influence functional impact more than external appearance.

Septoplasty addresses this by repositioning deviated cartilage and bone to create more symmetrical passages, while also providing cartilage for grafts used to reinforce other nasal structures.

Nasal Valve Insufficiency

The nasal valves represent the narrowest segments of the nasal airway and consequently the areas where even minor structural weakness produces significant airflow limitation. The internal nasal valve describes the angle where the upper lateral cartilage meets the septum—this triangular opening typically measures only a few millimetres in cross-section. The external nasal valve encompasses the nostril rim and lateral sidewall. Weakness in these regions causes visible collapse during inspiration—patients may observe their nostril walls ‘sucking inward’ when breathing deeply.

Nasal valve insufficiency often fails to respond to septoplasty alone because the valve structures require reinforcement through cartilage grafting techniques. Addressing valve collapse forms a central component of functional rhinoplasty.

Turbinate Enlargement

The turbinates are scroll-shaped projections inside each nasal passage that warm, humidify, and filter inspired air. When enlarged beyond normal dimensions—turbinate hypertrophy—they reduce the airway cross-section, creating persistent congestion even without excess mucus. Turbinate hypertrophy may develop in response to chronic inflammation, environmental irritants, or allergic conditions. Turbinate reduction performed alongside functional rhinoplasty can maximise airflow improvement.

Comparing Functional and Cosmetic Nasal Surgery

Functional rhinoplasty prioritises restoration of nasal breathing by correcting structural abnormalities. When patients meet specific clinical criteria demonstrating functional impairment, portions of surgical costs may qualify for Medicare rebates and private health insurance coverage.

Cosmetic rhinoplasty focuses on modifying external appearance—addressing dorsal humps, tip shape, or nostril asymmetry. These procedures do not qualify for Medicare or insurance rebates.

Many patients present with both breathing difficulties and aesthetic concerns. Septorhinoplasty addresses both objectives within a single procedure, recognising that structural changes made to improve breathing often affect external appearance, and aesthetic modifications may impact function if performed without attention to airway preservation.

Surgical Methods in Functional Rhinoplasty

Contemporary functional rhinoplasty emphasises structural reinforcement rather than reduction techniques. Building and strengthening the nasal framework provides more predictable functional improvement and maintains stability over time.

Spreader Grafts are thin cartilage strips positioned between the upper lateral cartilages and the dorsal septum, acting as spacers to widen the internal nasal valve. They may also improve the appearance of a crooked nose by straightening the middle vault.

Septal Reconstruction involves repositioning displaced cartilage and bone. In severe cases, Dr Turner may perform extracorporeal septoplasty—removing distorted cartilage, reshaping it, and repositioning it in a corrected configuration.

Alar Batten Grafts are curved cartilage segments positioned over the lateral nasal sidewall to reinforce the external nasal valve and prevent nostril collapse during inspiration.

Columellar Strut Grafts provide foundational support for the nasal tip, which may droop and obstruct the external valve when inadequately supported.

Turbinate Reduction increases the effective airway passage using conservative methods that preserve function while addressing obstruction.

Advantages of Combined Functional and Aesthetic Surgery

Combining functional and aesthetic nasal surgery offers practical advantages. Patients undergo anaesthesia and recovery once rather than twice. Addressing both concerns simultaneously ensures aesthetic modifications do not compromise breathing. The cartilage removed during septoplasty provides valuable grafting material—if procedures are staged years apart, this cartilage may no longer be available, requiring harvest from the ear or rib. A single combined procedure typically costs less than two separate surgeries.

The Surgical Experience

Dr Turner performs functional rhinoplasty under general anaesthesia at fully accredited private hospitals in Sydney and Brisbane. Procedure duration typically ranges from two to four hours.

Functional rhinoplasty is almost always performed using an open approach—a small incision across the columella providing complete visualisation of nasal structures. This proves essential for the accurate placement of structural grafts. The columellar incision heals well, typically fading significantly within several months.

Surgery proceeds systematically: the nasal skin envelope is elevated from the underlying framework, septal correction is performed, cartilage is harvested for grafting, grafts are placed to reinforce structural weak points, and turbinate reduction is performed when indicated. When bone repositioning is required, Dr Turner may employ ultrasonic piezoelectric instruments for precise work with reduced tissue trauma. An external splint protects the nose during initial healing.

Recovery Following Functional Rhinoplasty

Recovery from functional rhinoplasty follows a gradual timeline, with individual experiences varying according to procedure complexity and personal healing characteristics.

During the first week, patients wear an external nasal splint and may have internal splints in place. Breathing through the nose is typically difficult due to internal swelling and any splints present. Bruising around the eyes usually peaks around days two to three before beginning to resolve. Most patients manage discomfort adequately with prescribed pain medication during this period.

At the one to two week mark, splints are removed and many patients notice immediate airflow improvement, though substantial internal swelling remains. Return to desk-based work is generally possible within two weeks for most patients, while physically demanding occupations typically require four to six weeks. Contact sports and strenuous exercise should be avoided during initial healing as directed by Dr Turner.

Full functional improvement occurs gradually over several months as internal swelling resolves. Approximately 70 to 80 per cent of swelling resolution occurs within six months, with tip swelling being the slowest to settle. Final aesthetic results typically become apparent twelve to eighteen months post-surgery, once all swelling has resolved and tissues have fully settled.

Understanding Potential Risks

All surgical procedures carry risks. General risks include anaesthesia-related complications, bleeding, infection, and wound healing difficulties.

Rhinoplasty-specific risks include septal perforation causing crusting or whistling sounds, nasal asymmetry from unpredictable healing forces, and persistent breathing difficulties in complex cases. Temporary tip numbness is common and typically resolves over months. The global revision rate for rhinoplasty is reported at five to fifteen per cent.

Rare but significant risks include saddle nose deformity from insufficient structural support and empty nose syndrome associated with aggressive turbinate reduction. Dr Turner minimises risks through operating exclusively in accredited facilities, meticulous technique, and detailed aftercare. 

Medicare and Private Health Insurance

To qualify for Medicare Benefits Schedule item numbers, patients must demonstrate clinical documentation of structural obstruction, a NOSE scale score exceeding forty-five points, photographic evidence, and failure of conservative treatments. When criteria are satisfied, a portion of hospital and surgical costs may receive rebates even if aesthetic refinements are performed simultaneously.

The functional component may receive Medicare rebates and insurance coverage toward hospital fees. Any cosmetic component is considered a gap expense not eligible for rebates. During consultation, Dr Turner’s team provides detailed cost estimates and assists in determining potential coverage.

Your Consultation at FacePlus Aesthetics

Your journey begins with a comprehensive consultation at Dr Turner’s Sydney or Brisbane clinics.

The consultation includes a thorough evaluation of your nasal anatomy and breathing function through external and internal examination. Dr Turner discusses your symptoms in detail, understanding how they affect your daily activities, sleep, and exercise capacity. Assessment of your overall facial proportions helps determine how nasal modifications would relate to surrounding features.

Three-dimensional imaging assists in visualising potential outcomes, though it is important to understand that imaging represents a guide rather than a guarantee of results. Dr Turner explains recommended surgical techniques tailored to your specific anatomy and discusses realistic expectations, potential risks, and the recovery process. Documentation for potential Medicare and insurance claims is prepared when appropriate.

Multiple consultations are typically scheduled to ensure you feel fully informed and comfortable with your decision before proceeding. For patients travelling from interstate or regional areas, comprehensive information is available through our out-of-town patient resources.

Summary

Functional rhinoplasty addresses structural causes of nasal obstruction that medications cannot resolve. When aesthetic concerns exist alongside functional impairment, septorhinoplasty permits both objectives through a single procedure. The foundation of successful outcomes lies in accurate diagnosis, realistic expectations, and selection of a qualified Specialist Plastic Surgeon experienced in both functional and aesthetic nasal surgery.

Ready to discuss your concerns? Contact Dr Turner’s team to arrange a consultation.