Functional septorhinoplasty: rhinoplasty to breathe better

Functional septorhinoplasty (also called functional rhinoplasty) is the operation that straightens the septum and also corrects the outer parts of the nose — bones and cartilage — so that air can pass freely [1]. Its main aim is to breathe better; the shape of the nose may change, but that is not the purpose of the operation.

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.

The nasal valve and its collapse

The nasal valve is the part of the nose that offers the most resistance to the air you breathe in [3]. It lies in the middle-lower part of the nose, under the side cartilages. As air speeds up through that narrow point, the pressure inside drops; if the cartilages are weak or bent, the side wall of the nose is sucked in and closes: this is nasal valve collapse [3].

Typical signs: the nose feels more blocked when you breathe in deeply or during exercise, and sometimes you can see the side of the nose closing. The diagnosis is made mainly by examining the nose; there is no single test that confirms it [3]. Adhesive nasal strips or nasal dilators help some people and are useful to check whether the valve is the problem; steroid sprays do not help the valve if there is no rhinitis [3].

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].