As facial plastic surgeons, patients frequently come to us seeking rhinoplasty to change their nasal shape. But sometimes they also come with nasal breathing problems which also need correcting. And, sometimes patients with primary breathing problems may also need their nasal appearance altered as part of the correction of the breathing problem.
Let’s begin with a basic understanding of nasal anatomy. Think of your nose as having an upper, middle and lower third. The upper third is your nasal bone, shaped roughly like the roof of a house. The middle third cartilages which are attached to the underside of the bones, are also shaped like the roof of a house. The lower third, or tip, cartilages are shaped like the letter “m” – think of the McDonald’s golden arches! Running from top to bottom inside the nose is the midline cartilage wall called the septum – think of the wall running along the length of the attic roof separating it into two sides. The nostrils are the external openings where the air passes through past each side of the septum into the nasal cavity to the upper airway behind the nose, the nasopharynx.
If a person’s only problem is breathing, and this is due to a crooked nasal septum (usually from trauma, whether recognized or not), then a simple septoplasty to re-shape the septum may correct the problem. However, note there can be other causes of obstruction, such as allergies, which are not corrected by septoplasty.
In some cases, if the portion of the septum running along the bridge of the nose, or the part at the bottom between the nostrils, is crooked, the nasal bridge or tip itself may be crooked. In these cases a rhinoplasty to improve the deformity may be required in addition to the septoplasty, both for breathing and appearance correction. In other words, it may not be possible to straighten the septum without also straightening the nasal bridge and tip.
A common scenario is a patient presenting only to alter their nasal appearance. If their septum is crooked – as 70% of people’s are – that is corrected to ensure a good airway post-operatively. And, today, our philosophy generally is to not only re-shape the nose, but to re-create a structurally sound nose that will retain its beauty and function for life. We therefore frequently perform a septoplasty, even if the septum is straight, to obtain donor cartilage to use in the tip or bridge to re-shape and strengthen them.
As rhinoplasty surgeons, we often say, “Function and appearance are inseparable in rhinoplasty.” Now you know why.