Functional septorhinoplasty: rhinoplasty to breathe better

Video: septorhinoplasty, functional and cosmetic

In under eight minutes (in Spanish): what it is, how a bent septum and nasal walls that close when you breathe in block the nose, and why the functional and cosmetic parts are planned together. Then the operation step by step: the bones, the support grafts, the septum, the tip and the alae (the sides of the nostrils). Each step is shown first as an anatomical animation and then in real images.

It contains real surgical images.

What it is and how it differs from septoplasty and cosmetic rhinoplasty

• Septoplasty: it only straightens the septum, from inside the nose, without moving the outer parts [1]. See septoplasty (deviated septum surgery).
• Functional septorhinoplasty: straightens the septum and moves or reinforces bones and cartilage of the outside of the nose so that breathing improves [1][3].
• Cosmetic rhinoplasty: changes the shape of the nose for appearance; it is an elective operation [2]. If breathing is also a problem, both parts can be planned together: see ultrasonic rhinoplasty, cosmetic and functional.

What the operation is like

• Anaesthesia and duration: it is done under general anaesthesia [1]. It can take between 1 and 5 hours, depending on what needs correcting [1][2].
• Technique: «closed», with cuts inside the nose, or «open», with a small cut in the skin between the nostrils [1]. In a meta-analysis, both gave similar results in breathing, appearance, swelling and complications [7]. To support the valve, cartilage grafts are often used (for example from the septum itself) [3][6].
• External splint: a small plastic or metal splint is placed on the outside of the nose for one to two weeks [1][2].
• Bruising: bruising around the eyes is common for a few days and usually settles within a week [1].
• Hospital stay: sometimes you go home the same day and sometimes you stay one night [1]. Your surgeon will explain what is planned in your case.

Recovery week by week, and when the final result is seen

First days

Blocked nose and some discomfort that is controlled with painkillers; bruising around the eyes is common [1]. Internal splints or packs, if used, usually come out in 3 to 5 days [2].

Weeks 1-2

The external splint is removed after one to two weeks [1][2]. Bruising usually settles within a week [1]. Usual time off work: about two weeks; no strenuous exercise or contact sports, and ENT UK advises not flying for 14 days [1].

Weeks 3-12

Most of the swelling goes down within a few weeks, but the nose can take up to three months to settle [1]; swelling improves by 2 to 3 months [2].

Up to a year

The final result may not be visible for up to a year, sometimes longer [2]. As for breathing, in a meta-analysis of 16 studies the NOSE score fell on average by 43 to 50 points (out of 100) during the first year [4].

This is what the guidelines describe as usual; your surgeon will give you the instructions for your case. For surgery in general, see recovering from sleep apnea surgery.

Risks

• Further surgery: Between 5 and 10 out of 100 people need another operation to adjust the shape of the nose, and in about 1 out of 10 the septum bends again [1].
• Shape and support: Loss of support of the nose or contour irregularities [2].
• Breathing: Rarely, breathing can be worse than before [2].
• Skin: Tiny permanent red spots on the skin of the nose [2].
• Common to nasal surgery: It is normal for the nose to bleed a little after the operation; infection is rare; numbness of the tip of the nose, the upper teeth or the lip usually settles with time [1].

In studies of surgery on the nasal valve, the NOSE score improved substantially on average, although the studies are mostly observational and differ a lot from each other [5].