Functional Rhinoplasty

1. What is functional rhinoplasty?

Functional rhinoplasty is the Rhinoplasty that is aiming primarily at restoring the function of the nose, that is, normal breathing. During functional rhinoplasty, sophisticated surgical techniques are used to treat anatomical defects arising from an injury, hereditary factors, environmental irritants, and even a previous failed rhinoplasty. On the other hand, cosmetic rhinoplasty aims at the correction of the aesthetic problems of the nose and the improvement of its external appearance.

Nowadays, in the vast majority of cases, these two types of surgery are performed simultaneously, in the same surgical time. In this way, the benefit for the patient is twofold since he or she manages to obtain a nose that is beautiful and fits his or her face and breathes freely.

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2. Which anatomical defects of the nose can be treated with functional rhinoplasty?

The most common anatomical defects of the nose that are treated with functional rhinoplasty are the following:

• Deviated nasal septum
• Hypertrophy of the inferior turbinates
• Internal nasal valve collapse
• External nasal valve collapse
• Total loss of nasal skeleton support
• Nasal polyps

Let's briefly look at each one of them:

• Deviated nasal septum

The nasal septum is an osteochondral "wall" that divides the nasal cavity into two equal parts. This wall can become warped or broken, thus preventing the smooth flow of air from one side of the nose. The cause of this may be an injury, hereditary factors or even previous surgeries in the area. The problem is treated with με septoplasty surgery which takes place during functional rhinoplasty.

• Hypertrophy of the inferior turbinates

The inferior nasal turbinates are elongated anatomical structures inside the nose that consist of bone and mucous membrane. Their role is to warm, humidify and filter the air that travels from the nose to the lungs. There are three turbinates in each nasal chamber, but it is the lower (inferior) ones that cause most problems when they become over-inflated. The solution is to shrink them with radio-frequencies, ultrasound, laser or turbinoplasty.

• Internal nasal valve collapse

The internal nasal valve is the narrowest part of the nasal airway. It is formed by various anatomical structures and its role is to offer specific resistance to the flow of air through the nose, which is essential for the proper functioning of the lungs. Collapse of the internal nasal valve involves the narrowing of this area. It is caused by the weakening of the nasal cartilages or other anatomical defects, due to injury or previous rhinoplasty surgery (usually during the removal of the hump). During functional rhinoplasty, the Surgeon uses a series of cartilage grafts and applies special surgical techniques through which the anatomy and function of the internal nasal valve is restored.

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See Before & After Pictures of Rhinoplasty here

• External nasal valve collapse

The external nasal valve is located further out in the nasal cavity and is formed by the lower lateral cartilages and surrounding tissues. A weakening of these cartilages (e.g. due to injury or excessive reduction in size in a previous operation) is what most often causes the external nasal valve to become blocked. Again, the Surgeon uses grafts from the nasal septum, ear and more rarely from the patient's ribs to support and strengthen the lower lateral cartilages.

• Total loss of nasal skeleton support

In some cases, the osteochondral skeleton of the nose has little or no support, resulting in the structure of the nose practically collapsing. Naturally, this narrows the nasal airway and disrupts the smooth flow of air. The most common causes of this loss are:

• Serious nasal injury
• Previous surgery that resulted in excessive removal of cartilage and other tissues from the nose
• Congenital anomalies and diseases that destroy the skeleton of the nose

Again, functional rhinoplasty through specialized techniques and the use of grafts provides the solution.

• Nasal polyps

Nasal polyps are painless, soft growths inside the nasal cavity. It is believed that they are created due to chronic inflammation of the nasal mucosa and, when they increase in size, they cause stuffiness and difficulty in breathing. They almost always coexist with chronic sinusitis . Polyps are removed by functional endoscopic sinus surgery that takes place during functional rhinoplasty.

3. What symptoms are treated with functional rhinoplasty?

 Functional rhinoplasty successfully treats several symptoms caused by the anatomical defects mentioned above. These symptoms are:

• Difficulty breathing through the nose
• Nasal congestion (stuffy nose)
• Snoring & Sleep Apnea
• Sleep apnea
• Decreased sense of smell and taste
• Pain in the face and headache
• Runny nose
• Frequent sinus infections
• Pharyngitis
• Nosebleed

Can functional rhinoplasty be combined with cosmetic rhinoplasty?

Nowadays, functional rhinoplasty is inextricably linked with cosmetic rhinoplasty. Both are governed by the same principles to the extent that they are essentially a single surgical procedure. Therefore, their combination is almost always the norm providing the patient with the double benefit of a beautiful and functional nose. Common cosmetic problems that are treated during this combined operation are:

• Nasal hump
• Crooked nose
• Thick, asymmetrical, droopy or over-projected tip
• Long nose
• Wide nose
• Asymmetries and deformities due to injury or previous failed operations

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210 69 90 484 & 6944 221 223

5. Which surgeon is suitable to perform the operation?

The appropriate surgeon to perform the operation of the functional rhinoplasty is the specialized nasal surgeon otolaryngologist. As is easily understood, this specific operation is especially delicate and requires excellent theoretical knowledge and technical training on the doctor’s end. This is acquired through actual exposure and further training in special rhinology centers where the surgeon becomes qualified to handle the nose as a unified functional and aesthetic entity. An aesthetically acceptable nose that does not breathe does not fulfill its mission and this is something that every nose Surgeon’s must be conscious of. Besides, the complexity and variety of the functional problems of the nose demand that they be treated by a Nose Surgeon Otolaryngologist. The reason is simple and lies in the fact that no specialty other than otolaryngology provides the theoretical background, surgical techniques and equipment to effectively approach the specific problems.

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210 69 90 484 & 6944 221 223

6. What will happen during the first visit to your surgeon?

During the first visit to your surgeon, the following will typically happen:

• Medical History. You will talk to your doctor about what is bothering you aesthetically in your nose and what symptoms you have with your breathing. You will also be asked if you have had any previous surgery or any other health problems.

• Clinical examination. The doctor will thoroughly examine the outside of your nose and evaluate any deformities such as a hump, a bulbous or droopy tip, a crooked nose, etc. Nasal endoscopy is extremely important. During this examination, the inside of the nose is assessed, and various anatomical issues are diagnosed, such as deviated septum, inferior turbinates hypertrophy, nasal polyps, etc. The presence of even one of them necessitates the operation of functional rhinoplasty. In some cases, an additional CT or MRI scan will be requested for further evaluation.

• Before and after photos. In case you decide to undergo a combination of cosmetic and functional rhinoplasty, it is very useful to see before and after photos of previous cases with your doctor. Also, the doctor will take pictures of your own nose from different angles. This will help you better understand the philosophy of the operation as well as your own needs more clearly.
• Setting goals. Through this elaboration that takes place during the first visit you will set realistic goals together with your surgeon. These will concern both the function of breathing and the appearance of the nose.
• Price. The price of functional rhinoplasty depends on the severity of the problem to be corrected and therefore on the complexity of the operation. It also depends on the hospital where you choose to be operated on and whether you have private insurance that covers the functional part of the operation.

7. Open or closed functional rhinoplasty?

Functional rhinoplasty can be done with either the closed or the open approach. Depending on the case, the two methods can offer excellent results both aesthetically and functionally. But it is an indisputable fact that open rhinoplasty is the most appropriate for the most demanding cases. The reason lies in the fact that it provides a clearly better surgical field than the closed one. It thus allows more and finer surgical manipulations, while at the same time provides the possibility for easier retrieval and more precise placement of grafts.

What should a patient be aware of after functional rhinoplasty?

The postoperative course of functional rhinoplasty is the same as that of classic rhinoplasty. Therefore, the instructions given to the patient are identical and you can read them in detail in the article: What should one watch out for after Rhinoplasty?

Functional rhinoplasty is a demanding but also charming operation. And its charm lies precisely in the fact that in the hands of the right surgeon it can offer the patient a double gift. Well-being that comes from free breathing and confidence that comes from a renewed appearance.

Dr. Michail Tsounis MD, PhD has been trained in Functional and Aesthetic Rhinoplasty in paid posts at Charing Cross Hospital of the Imperial College of Medicine in London, Queen's Medical Center of the University of Nottingham and Academic Medical Center of the University of Amsterdam. He attended the official surgical specialization programs of the United Kingdom and the Netherlands on the specific subject (Fellowships) and was trained by the leaders in this field such as Prof. Gilbert Nolst Trenite, Prof. Wytske Fokkens, Prof. Hesham Saleh, Prof. Anshul Sama and Dirk Jan Menger. He remains an active member of the ENT department of the Imperial College of Medicine and the ENT clinic of the University of Nottingham as an Honorary Rhinology Fellow, participating regularly in the surgery program as well as in research activities. Dr. Tsounis performs on a weekly basis a significant number of Rhinoplasty operations both in Greece and abroad, covering the entire spectrum of modern Functional and Aesthetic Rhinoplasty in patients that are operated for the first time as well as in cases that require revision surgery. He is a regular member of the European Academy of Facial Plastic Surgery and the European Rhinological Society, and concurrently one of the Specialist Otorhinolaryngologists of the General Medical Council of England.