Functional Rhinoplasty by Dr Turner in Sydney & Brisbane
Functional rhinoplasty is a specialised surgical procedure designed to address both the form and function of your nose. The primary goal is to restore proper airflow through the nasal passages, alleviating symptoms such as nasal obstruction, difficulty breathing, snoring, or sleep apnoea. While the procedure focuses on functional improvements, it often results in aesthetic enhancements, contributing to a more balanced and harmonious facial appearance.
Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) with clinics in Sydney & Brisbane. With over a decade of experience in facial surgery, Dr Turner specialises in functional rhinoplasty, prioritising both aesthetic and functional aspects of nasal surgery to help patients achieve optimal outcomes.
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Understanding Functional Rhinoplasty Surgery
What is Functional Rhinoplasty?
Functional rhinoplasty is a specialised surgical procedure designed to correct structural abnormalities within the nose that impair breathing and nasal function. Unlike cosmetic rhinoplasty, which focuses primarily on enhancing appearance, functional rhinoplasty addresses issues that obstruct proper airflow while maintaining or improving the nose’s aesthetic appearance.
Nasal breathing is an essential function that impacts various aspects of health, including sleep quality, physical performance, and overall well-being. For individuals with structural nasal issues, chronic nasal obstruction can significantly impair breathing and quality of life.
Nasal Anatomy and Airflow
Understanding the anatomy of the nose helps explain why functional rhinoplasty may be necessary. The nose contains several key structures that work together to facilitate breathing:
Nasal Septum: The thin wall that separates the left and right nasal cavities, consisting of both cartilaginous and bony components. When deviated or crooked, it can block airflow and cause breathing difficulties.
Nasal Valves: The narrowest parts of the nasal airway, located just inside the nostrils. The nasal valve is divided into internal and external components. When these areas are weak or collapse during inhalation, it can severely restrict breathing.
Turbinates: Bony structures covered by mucous membranes inside the nasal passages that help warm and humidify inhaled air. When enlarged (turbinate hypertrophy), they can significantly obstruct breathing.
Conditions Treated by Functional Rhinoplasty
Functional rhinoplasty can address various structural issues that cause breathing difficulties:
Deviated Septum
A deviated septum occurs when the central wall separating the nostrils is displaced or bent to one side, leading to breathing difficulties, frequent sinus infections, and snoring. Septoplasty, often performed as part of functional rhinoplasty, straightens the septum and improves airflow through both nasal passages.
Nasal Valve Collapse
Nasal valve collapse occurs when the airway inside your nose narrows due to weakened cartilage support. This is the most common cause of external nasal airway obstruction and can result from natural anatomy, previous surgery, trauma, or ageing. During inhalation, the nasal sidewalls may collapse inward, restricting airflow. Functional rhinoplasty strengthens these areas using specialised techniques such as spreader grafts, batten grafts, or strut grafts to maintain open airways.
Turbinate Hypertrophy
The turbinates are mucous membrane-covered structures that extend the length of the internal nasal cavity. When the inferior turbinates become enlarged, they can significantly obstruct airflow. Turbinate reduction may be performed in conjunction with functional rhinoplasty to improve breathing.
Nasal Obstruction from Previous Surgery or Trauma
Injury or previous unsuccessful nasal surgery can result in structural problems affecting breathing. Nasal trauma can cause significant injury to both the soft tissues of the nose and the underlying framework. Functional rhinoplasty can correct these issues, restoring proper nasal function.
Functional vs. Cosmetic Rhinoplasty
While both procedures may use similar surgical techniques, their primary objectives differ:
Functional Rhinoplasty: Prioritises restoring proper nasal breathing and function by addressing structural abnormalities that impair airflow. The focus is on correcting internal nasal structures to improve breathing.
Cosmetic Rhinoplasty: Focuses on enhancing the nose’s aesthetic appearance to complement facial features better. Changes may include reshaping the nasal tip, reducing a dorsal hump, or adjusting nostril size.
Many patients benefit from a combined approach that addresses both functional and aesthetic concerns simultaneously. This is known as septorhinoplasty. Dr Turner’s expertise in both aspects allows for comprehensive nasal surgery that improves breathing while maintaining or enhancing appearance.
Am I a Suitable Candidate?
Determining if functional rhinoplasty is appropriate for your nasal breathing issues begins with understanding your symptoms and their impact on your quality of life. You may be a suitable candidate for functional rhinoplasty if you:
- Struggle with persistent nasal congestion that doesn’t respond to medications
- Experience difficulty breathing through one or both sides of your nose
- Have been diagnosed with structural nasal issues like a deviated septum
- Frequently breathe through your mouth, especially during sleep
- Experience snoring or sleep disruptions related to nasal obstruction
- Have suffered nasal trauma that affected your breathing
- Had previous nasal surgery with unsatisfactory functional results
- Experience a reduced sense of smell and taste due to impaired airflow
- Suffer from recurrent sinus infections or sinus pressure headaches
Medical Considerations
Before proceeding with functional rhinoplasty, Dr Turner will conduct a thorough assessment including:
- Review of your complete medical history
- Physical examination of your nose, both externally and internally
- Nasal endoscopy to assess internal nasal anatomy
- Review of CT scans if required
- Assessment of previous treatments and their outcomes
- Evaluation of overall health status and fitness for surgery
NOSE Score Assessment
The Nasal Obstruction Symptom Evaluation (NOSE) Scale is a validated questionnaire used to assess the severity of nasal obstruction and functional impairment. This self-reported score evaluates how breathing difficulties affect your quality of life. In Australia, a NOSE score of greater than 45 is one of the criteria used to determine eligibility for Medicare rebates for functional rhinoplasty. Dr Turner will assess your NOSE score during your consultation.
Contraindications
Functional rhinoplasty may not be suitable for individuals who:
- Have unrealistic expectations about surgical outcomes
- Are smokers unwilling to cease smoking before and after surgery
- Have uncontrolled medical conditions such as diabetes or bleeding disorders
- Are you experiencing active nasal or sinus infections
- Have certain psychological conditions that may affect their decision-making
How is Functional Rhinoplasty Performed?
Anaesthesia and Surgical Setting
Functional rhinoplasty is always performed under general anaesthesia in a fully accredited hospital, with the assistance of a qualified anaesthetist. Depending on the complexity of the procedure, surgery may take anywhere from 2 to 4 hours. Patients can typically be discharged home the same day.
Surgical Approach
Dr Turner may use either an open (external) or closed (endonasal) approach depending on the complexity of your case:
Open Rhinoplasty: A small incision is made across the columella (the tissue between the nostrils), allowing full access to the nasal structures. This approach provides excellent visibility for complex reconstructions. The incision typically heals very well and becomes imperceptible.
Closed Rhinoplasty: All incisions are made within the nostrils, resulting in no visible external scars. This approach is suitable for less complex corrections.
Step-by-Step Surgical Process
1. Incision and Exposure
The procedure begins with carefully placed incisions. The skin and soft tissues of the nose are gently lifted off the underlying bone and cartilage framework, providing the necessary visibility and access to the internal structures that require modification.
2. Component Separation
The nasal structures are separated into individual components to allow precise adjustment of each element. This step is crucial for addressing specific functional issues without compromising other nasal areas.
3. Harvesting Cartilage Grafts
Cartilage grafts are often required to reinforce nasal structures. The choice of donor cartilage depends on the availability and quantity required. The preferred source is septal cartilage; however, if this is unavailable or insufficient, rib (costal) cartilage may be harvested. In some cases, ear cartilage may also be used.
4. Septoplasty (Correcting the Septum)
If a deviated septum is present, a septoplasty is performed to straighten it. This involves removing or repositioning the bent portions of cartilage and bone to create a straight septum and improve airflow through both nasal passages.
5. Nasal Osteotomies
When the nasal bones require repositioning, precise bone cuts (osteotomies) are made using ultrasonic piezotome instruments. This advanced technology enables accurate reshaping of the nasal bones with minimal trauma to surrounding tissues, thereby reducing postoperative swelling and bruising.
6. Nasal Valve Correction
Spreader grafts, batten grafts, or strut grafts may be inserted to widen the internal or external nasal valve area. These grafts prevent collapse during inhalation and enhance nasal airflow.
7. Tip Refinement
Modifications to the nasal tip cartilages may be performed using various techniques, such as excising excess cartilage, placing tip sutures, and using strengthening cartilage grafts. Septal extension grafts (columella grafts) may be used to support the new nasal tip position and provide structural stability.
8. Closure and Final Adjustments
The nasal skin and soft tissues are redraped over the new framework. Incisions are meticulously closed with fine sutures to promote optimal healing. If necessary, adjustments are made to refine the nostril shape and width through techniques such as alar or nostril sill reduction.
Recovery and Aftercare
Following surgery, you will be monitored before being discharged home the same day. A nasal splint will be placed on the outside of your nose, and internal splints may be used to support healing. In the first week, expect swelling and bruising around the nose and eyes, mild discomfort, and nasal congestion. Keep your head elevated, avoid strenuous activities, and attend your follow-up appointment within 7 to 10 days for splint removal. Most patients return to light activities within 10 to 14 days, with more vigorous exercise typically postponed for at least four weeks.
Recovery continues well beyond the initial weeks, with breathing gradually improving as internal swelling resolves over 3 to 6 months. Final results may take up to 12 months to fully emerge as residual swelling settles. Results vary between individuals depending on factors such as the severity of the initial obstruction, anatomy, and healing characteristics. While functional rhinoplasty primarily addresses breathing concerns, improvements to external nasal appearance may also occur as part of the reconstructive process.
Risks and Complications
As with any surgical procedure, functional rhinoplasty carries specific risks that Dr Turner will discuss thoroughly during your consultation. General surgical risks include those associated with general anaesthesia, bleeding, infection, and adverse reactions to medications. Procedure-specific risks may include temporary numbness of the nasal tip, nasal asymmetry, breathing difficulties during healing, and in rare cases, septal perforation or the need for revision surgery.
Dr Turner minimises these risks through comprehensive pre-operative assessment, surgery performed only in fully accredited hospital facilities with qualified anaesthetists, meticulous surgical technique, and regular post-operative monitoring. Contact Dr Turner’s clinic or seek medical attention if you experience excessive bleeding, signs of infection such as increasing pain or discharge, high fever, or any other concerns about your recovery.
Medicare and Health Insurance Coverage
Unlike purely cosmetic procedures, functional rhinoplasty may be partially covered by Medicare and private health insurance when performed to correct medically necessary breathing impairments.
Medicare Benefits Schedule (MBS)
Medicare may provide a rebate for the functional component of your procedure if it meets specific criteria. The Medicare Benefits Schedule outlines item numbers for rhinoplasty when surgery is indicated for:
- Airway obstruction with a self-reported NOSE Scale score of greater than 45; or
- Significant acquired, congenital, or developmental deformity
Benefits are payable for septoplasty (MBS Item 41671) when performed in conjunction with rhinoplasty. Full clinical details must be documented, including pre-operative photographic and/or NOSE Scale evidence demonstrating the clinical need for the service, as this may be subject to audit.
Private Health Insurance
Private health insurance may cover hospital fees and a portion of the surgical fees if you meet current Medicare eligibility criteria and have an MBS item number provided by your surgeon. Each health insurance provider offers different levels of coverage, so it is essential to contact your insurer before surgery to understand your specific benefits and any out-of-pocket expenses.
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by Dr Turner, Specialist Plastic Surgeon
