Functional Rhinoplasty

A valve is a structure or device located at a transition point between two spaces. It functions to help facilitate and/or regulate flow between the spaces. The nose is built with both an external valve at the nostril opening and an internal valve just inside the nasal cavity. The external valve is formed primarily by skin and soft tissue found in the wing, or ala, of the nose. Together with the midline septum and tip cartilages, the alae make up the shape of the nostrils. The internal valve is comprised of cartilages that extend from the nasal bones and attach in the midline to the nasal septum. Much like an awning or the sides of a tent, these tissues drape off of the septum and tip cartilages and extend toward the cheek, making up the sidewalls of the nose.  Just like the septum, these tissues can become distorted during facial growth or trauma, causing asymmetries in one or both sides of the nose. In addition, these tissues can weaken with age or as a result of prior nasal surgery. The result can be a valve that is too narrow for adequate air passage, or one that is too weak to remain open during inspiration.

Nasal valve compromise is a common finding in patients with nasal obstruction. This is particularly true in patients with persistent nasal restriction following a prior surgery, such as septoplasty or rhinoplasty. Sometimes patients identify these problems on their own when they find their nasal breathing improves by pulling on their cheek or using products like Breathe Right Strips®.  If the nasal valve is compromised, augmentation techniques using your own cartilage may provide you with a more stable, patent valve throughout the day.

Dr. Stallworth has a particular interest in nasal valve surgery for a nose job and is skilled at addressing each of the previously mentioned issues using a variety of techniques. These include, but are not limited to, batten grafting, spreader grafting, butterflying grafting, alar rim augmentation, and flaring sutures. Each has specific indications and may be the answer for one patient but inappropriate for another. Based on your history and nasal assessment, Dr. Stallworth will identify nasal valve issues if they exist and, if found, will help you to understand how these techniques can be tailored to address your unique nasal valve concern.

Turbinates are shelf-like structures that protrude from the nasal sidewalls and extend the length of the nasal cavity. They are made up of a bony shelf lined with nasal mucosa.  Turbinates work much like the grille in a radiator, exposing the air we breathe to the greatest possible surface area. In doing so, they humidify and warm our inspired air. They also secrete mucus to trap and filter allergens, infectious agents, and other particles from the air.  When stimulated, the mucosa swells. This phenomenon is responsible for a stuffy nose when we have a cold, a sinus infection, or are exposed to allergens and irritants. 

Just like a skin callus, turbinates may enlarge and thicken over time from repeated exposure to irritants. Often, this thickening and mucus production can be reduced with medications such as oral antihistamines or nasal steroid sprays. However, there are instances where they enlarge, or hypertrophy, to a degree that is no longer amenable to medication.  In these cases, reducing the size of the turbinates can make a profound impact on nasal breathing. 

In the past, large portions of the turbinates were excised, permanently removing them from the nose. Unfortunately, this was found to deprive patients of the valuable nasal lining that humidifies and warms nasal air. Instead of remaining moist like the lining of the mouth, the nose would become dry. Also, the loss of all turbinate structures would remove the resistance needed to direct air to the back of the throat and onto the lungs, worsening nasal breathing. For these reasons, modern techniques are now employed to reduce turbinate size from the inside out, reducing their size to a more manageable volume while leaving the overlying lining intact.  Today, this is achieved using small electric, radiofrequency, or shaving devices inserted into the turbinate through a small needle-sized incision. Turbinate surgery may be done alone or, more frequently, in combination with other nasal surgeries.

The nasal septum is the wall that divides the nose into two halves. It is made of cartilage anteriorly and is composed of bone further back into the nasal cavity. Not only does it provide a partition between the two nasal passages originating at the nostrils, but it also provides support for the nose. The septum can be thought of as a load-bearing wall in a building.  Superiorly, it provides support to the roof of the nose and the nasal cavity. Anteriorly, it supports nasal length, nasal tip projection, and tip rotation. In these ways, the septum is truly the foundation of the nose.

A septum that deflects to the right or left can dramatically reduce airflow on that side of the nose. This deflection may be inherited, may be the result of nasal trauma, or may arise over time due to extrinsic forces that influence the growth and shape of the septal cartilage.  Irrespective of the cause, septal deviation is a common cause of nasal obstruction.

Septoplasty, or septal straightening surgery, is traditionally performed through an incision on the inside of the nasal cavity just inside the nostril. The lining of the septum is elevated, and the deflected cartilage and/or bone are removed or reshaped to fall within the nasal midline.  The incision is then closed with dissolving sutures. The procedure can be performed alone or in concert with additional nasal procedures.

Many patients who require functional rhinoplasty also have cosmetic concerns involving the bridge, tip, symmetry, or overall shape of the nose. Since both procedures involve the same underlying framework, functional and cosmetic rhinoplasty are commonly performed together. This allows breathing improvements and aesthetic refinements to be achieved simultaneously.

Facial injuries can alter both the appearance and function of the nose. Trauma reconstruction may be combined with functional rhinoplasty to restore structural support, improve breathing, and address deformities caused by previous fractures or injuries.

Patients with prior nasal fractures often experience persistent breathing difficulties due to displaced bones or cartilage. Functional rhinoplasty may be combined with fracture correction techniques to restore proper alignment and improve airflow through the nasal passages.