Surgery of the Nose: Improving Form and Function
Each year thousands of people undergo surgery of the nose. Nasal Surgery
may be performed for cosmetic purposes, or a combination procedure to
improve both form and function. It also may alleviate or cure nasal
breathing problems, correct deformities from birth or injury, or
support an aging, drooping nose.
Patients who are considering nasal surgery for any reason should
seek a doctor who is a specialist in nasal airway function, as well as
plastic surgery. This will ensure that efficient breathing is as high a
priority as appearance.
Can Cosmetic Nasal Surgery Create a "Perfect" Nose?
Aesthetic nasal surgery (rhinoplasty)
refines the shape of the nose, bringing it into balance with the other
features of the face. Because the nose is the most prominent facial
feature, even a slight alteration can greatly improve appearance. (Some
patients elect chin augmentation in conjunction with rhinoplasty to
better balance their features.) Rhinoplasty alone cannot give you a
perfect profile, make you look like someone else, or improve your
personal life. Before surgery, it is very important that the patient
have a clear, realistic understanding of what change is possible as
well as the limitations and risks of the procedure.
type, ethnic background, and age will be among the factors considered
preoperatively by the surgeon. Except in cases of severe breathing
impairment, young patients usually are not candidates until their noses
are fully-grown, at 15 or 16 years of age. The surgeon will also
discuss risk factors, which are generally minor, as well as where the
surgery will be performed-in a hospital, freestanding outpatient
surgical center, or a certified office operating room.
To reshape the nose, the skin is lifted, allowing
the surgeon to remove or rearrange the bone and cartilage. The skin is
then redraped and sutured over the new frame. A nasal splint on
the outside of the nose helps retain the new shape during healing. If
soft, absorbent material is placed inside the nose to stabilize the
septum, it will normally be removed the morning after surgery. External
nasal dressings and splints are usually removed five to seven days
When Should Surgery Be Considered to Correct a Chronically Stuffy Nose?
Millions of Americans perennially suffer the
discomfort of nasal stuffiness. This may be indicative of chronic
breathing problems that don't respond well to ordinary treatment. The
blockage may be related to structural abnormalities inside the nose or
to swelling caused by allergies or viruses.
There are numerous causes of nasal obstruction. A
deviated septum (the partition between the nostrils) can be crooked or
bent as the result of abnormal growth or injury. This can partially or
completely close one or both nasal passages. The deviated septum can be
corrected with a surgical procedure called septoplasty. Cosmetic
changes to the nose are often performed at the same time, in a
combination procedure called septorhinoplasty.
of the turbinates is yet another cause of stuffiness. (The turbinates
are the tissues that line the inside of the nasal passages.) Sometimes
the turbinates need treatment to make them smaller and expand the nasal
passages. Treatments include injection, freezing, and partial removal.
Allergies, too, can cause internal nasal swelling, and allergy
evaluation and therapy may be necessary.
Can Surgery Correct a Stuffy, Aging Nose?
Aging is a common cause of nasal obstruction.
This occurs when the cartilage in the nose and its tip are weakened by
age and droop because of gravity. This causes the sides of the nose to
collapse inward, obstructing airflow. Mouth breathing or noisy and
restricted breathing are common.
Try lifting the tip of your nose to see if you
breathe better. If so, the external adhesive nasal strips that athletes
have popularized may help. Or talk to a facial plastic
surgeon/otolaryngolgist about septoplasty, which will involve trimming,
reshaping or repositioning portions of septal cartilage and bone. (This
is an ideal time to make other cosmetic improvements as well.) Internal
splints or soft packing may be placed in the nostrils to hold the
septum in its new position. Usually, patients experience some swelling
for a week or two. However, after the packing is removed, most people
enjoy a dramatic improvement in breathing.
What Treatment is Needed for a Broken Nose?
Bruises around the eyes and/or a slightly crooked
nose following injury usually indicate a fractured nose. If the bones
are pushed over or out to one side, immediate medical attention is
ideal. But once soft tissue swelling distorts the nose, waiting 48-72
hours for a doctor's appointment may actually help the doctor in
evaluating your injury as the swelling recedes. (Apply ice while
waiting to see the doctor.) What's most important is whether the nasal
bones have been displaced, rather than just fractured or broken.
markedly displaced bones, surgeons often attempt to return the nasal
bones to a straighter position under local or general anesthesia. This
is usually done within seven to ten days after injury, so that the
bones don't heal in a displaced position. Because so many fractures are
irregular and won't "pop" back into place, the procedure is successful
only half the time. Displacement due to injury often results in
compromised breathing so corrective nasal surgery, typically
septorhinoplasty, may then be elected. This procedure is typically done
on an outpatient basis, and patients usually plan to avoid appearing in
public for about a week due to swelling and bruising.
Will Insurance Cover Nasal Surgery?
Insurance usually does not cover cosmetic
surgery. However, surgery to correct or improve breathing function,
major deformity, or injury is frequently covered in whole or in part.
Patients should obtain cost information from their surgeons and discuss
with their insurance carrier prior to surgery.
© 2004 AAO-HNS/AAO-HNSF