Despite some misconceptions to the contrary, not all nose jobs or rhinoplasty surgeries are performed to make people look good, although they certainly can do that.  A fair number of rhinoplasties are performed for valid medical reasons.  There are many reasons why a rhinoplasty can be considered a medical necessity, including accidental breakage, insertion of a foreign object, and sinus or other infections.  Most commonly, medically required nose jobs are performed to address constriction of the patient’s airway issues and subsequent breathing problems caused by accident or nature and which may become worse over time if not addressed.

Obstruction of the Nasal Passages and Rhinoplasty

There are usually three factors at play when it comes to obstruction of the nasal passages.  Most well known among these is the deviated septum.

·         The septum is the divider made of cartilage that separates the two sides of the nose.  In most cases, the septum is, for all intents and purposes, straight, allowing for all but equal airflow through both sides of the nose.

·         When the septum deviates from this central location, either as the result of an accident or perhaps just being formed that way by nature, the airway on one side of the nose is diminished, causing breathing problems.

·         Spotting a deviated septum is very easy, and can be done by non-medical personnel.  The problem arises in attempting to correct the deviation, especially when the deviated portion of the septum may be in the main support area for the ridge of the nose.  Removal of a part of the septum and grafting can be used to correct the deviation and improve airflow.

A second factor in nasal airway obstruction is called enlargement of the turbinates inside one or both sides of the nose.

·         The turbinates are small projections located along the interior walls (across the passage from the septum) of the nasal passage that assist in regulating, filtering and humidifying air as it in inhaled.

·         If the turbinates become enlarged, usually as a result of allergies or an infection, they reduce the airflow through the nasal passage, making it more difficult to breathe.

·         Because the turbinates are essential to the healthy respiration of a person, it is important to leave them as intact as possible when performing corrective rhinoplasty.

·         If too much of the enlarged turbinate is removed to allow for the freer passage of air, that air will not be properly regulated on its way to the lungs, and can lead to further breathing problems in the sinuses, throat, and lungs.

The third factor related to the obstruction of a person’s nasal passages is internal nasal valve collapse.

·         Everyone has two nasal valves. One involves the muscles around the nostrils and is called the external valve, while the other consists of a transition area at the narrowest part of the nose between the skin and the inside lining of the nasal passage.

·         It is this valve that is most problematic and is addressed during rhinoplasty.  A piece of cartilage in the internal nasal valve usually helps hold open the airway during breathing.

·         If damaged or weakened the airway collapses and makes it harder for air to pass through.  A cheap and fairly effective means of addressing this valve problem is the use of nasal strips applied with adhesive across the bridge of the nose and onto the cheeks.  The springiness within the nasal strips allows for the adhesive to pull open the internal nasal valve to allow for easier breathing.

·         If a permanent solution is sought via rhinoplasty, a cartilage graft can be placed in the area of the internal valve to act as a spreader.

While cosmetic surgeons are qualified to complete the procedures necessary to remedy these breathing problems, in some cases an otolaryngologists (or ENTs) may be brought in for assistance in the repair of nasal passage restrictions.  For the best possible outcome, it is important that the prospective patient investigate their specific problem and discuss their options with whichever doctor they choose.