Functional rhinoplasty corrects the internal structures that obstruct the passage of air: a deviated septum, enlargement of the inferior turbinates, collapse of the nasal valves, the after-effects of injury and congenital or acquired malformations. Its purpose is not to change the external shape, although it can be combined with cosmetic rhinoplasty.
The symptoms — persistent congestion on one side only, mouth breathing at night, snoring, loss of smell — can have various causes. It is the examination of the inside of the nose by rhinoscopy or nasal endoscopy that confirms the obstruction is anatomical.
It is carried out in theatre under general anaesthetic and takes two to three hours. The septoplasty is approached through internal incisions in the lining, and is completed with turbinoplasty, reconstruction of the nasal valves or structural grafts according to which structures are affected; the closure leaves no visible scars.
Patients return to their routine between five and seven days, and splints and packs are removed at the clinic within a few days. Breathing improves gradually: by around three months most patients are breathing freely.
During the first few days a feeling of congestion, facial swelling and small amounts of bleeding are all common. The advice is not to blow the nose, to avoid physical exertion and not to sleep face down.
Functional rhinoplasty is an operation intended to correct internal abnormalities of the nose that affect breathing. Unlike cosmetic rhinoplasty, whose main aim is to improve the external shape of the nose, functional rhinoplasty concentrates on restoring proper breathing, although the two can be combined in a single operation.
At the Instituto de Cirugía Plástica del Mediterráneo, in Valencia, we carry out this procedure with an integrated approach, assessing not only the appearance of the nose but its ability to let air flow properly. Patients who come with symptoms of persistent nasal obstruction, difficulty breathing at night or chronic congestion can benefit greatly from this technique.
The functional and the cosmetic route share the same surgical approach; it is described in the guide to rhinoplasty.
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A functional rhinoplasty is an operation that corrects internal structures of the nose which partly or wholly obstruct the passage of air. These problems are often the consequence of congenital malformations, injury, deviation of the nasal septum or enlargement of the turbinates. The aim is not to change the visible shape of the nose but to restore how it works, stably and safely.
The main reasons for which this surgery is indicated include:
Deviation of the nasal septum (a deviated septum)
Enlargement of the inferior turbinates
Collapse of the nasal valves
After-effects of injury to the nose
Congenital or acquired malformations
A clinical assessment determines whether the origin of the breathing problems lies in the internal structure of the nose. In most cases the patient is unaware that a deviation or an internal obstruction is limiting their ability to breathe efficiently.
“Not breathing well through the nose” is not a single problem. The air can meet three different narrowings: a deviated septum that narrows one of the passages, an enlarged inferior turbinate taking up space in the airway, or a nasal valve that collapses on breathing in — the narrowest point in the whole nose, at the angle formed by the upper lateral cartilage and the septum. They can coexist in the same nose, and which one predominates is what decides the technique: septoplasty, turbinoplasty or reinforcement of the valve. That is why examining the inside of the nose is not a preliminary formality but what determines the operation. Original diagram by the Instituto de Cirugía Plástica del Mediterráneo, simplified for general readers.
Symptoms that point to a nasal problem
Patients with structural abnormalities of the nose commonly have some of the following symptoms:
Persistent nasal congestion, particularly on one side only
Mouth breathing, above all at night
Snoring or mild sleep apnoea
Headache associated with the effort of breathing
Reduced sense of smell or sensitivity to odours
A feeling of being short of breath on exercise
Repeated upper respiratory infections
While these symptoms can have many causes, a detailed medical examination of the inside of the nose by rhinoscopy or nasal endoscopy identifies anatomical obstructions.
Septoplasty: the key to functional correction
Septoplasty is one of the most frequent procedures within functional rhinoplasty. It consists of correcting a deviation of the nasal septum, the sheet of cartilage and bone that divides the nose into two cavities. When that septum is deviated, it reduces the flow of air in one or both nasal passages.
During surgery the septum is reached through internal incisions, repositioned, and the excess cartilage or bone that blocks the air is removed. The result is a marked improvement in breathing without altering the external shape of the nose, unless the patient also asks for a cosmetic correction.
Septoplasty is sometimes combined with other complementary techniques, such as:
Turbinoplasty: reducing the size of the turbinates to free up space in the airway
Reconstruction of the nasal valves: stabilising the internal walls of the nose that collapse on breathing in
Structural grafts: to reinforce weak areas that prevent proper breathing
How is a functional rhinoplasty carried out?
The operation is carried out in theatre under general anaesthetic. It usually takes 2 to 3 hours, depending on which structures are affected and on whether it is combined with a cosmetic rhinoplasty.
The most usual steps of the operation are:
Assessment of the nasal anatomy during surgery
An internal incision in the lining of the nose
Correction of the septum: removing or reshaping the deviated segments
Reducing or repositioning the turbinates where necessary
Reinforcing structures with grafts, where there is nasal collapse
Closing the incisions with no visible scars
Placing an external splint and stabilising the inside with soft packs or silicone sheets
At the Instituto de Cirugía Plástica del Mediterráneo we use leading-edge technology that allows a precise operation, with minimal disturbance to the tissues and a quick recovery.
Recovery after a functional rhinoplasty
Recovery is similar to that of a conventional rhinoplasty. In general the patient can resume their normal routine in 5 to 7 days, although breathing improves gradually over the following weeks.
The most frequent symptoms during the first few days are:
A feeling of nasal congestion
Swelling of the face
Discharge or small amounts of bleeding
Discomfort from breathing through the mouth
Splints and packs are temporary and are removed at the clinic within a few days. Following the medical team’s advice is important in avoiding complications, and includes:
Not blowing the nose
Avoiding physical exertion
Not sleeping face down
Not going into dry or heavily polluted environments
Breathing improves gradually and, in most cases, significantly. By three months most patients have regained free nasal breathing, with no obstruction and no recurrence of their earlier symptoms.
The benefits of functional rhinoplasty
The benefits of this surgery go beyond the clinical. Breathing well has a direct effect on the quality of sleep, on physical performance, on the ability to concentrate and on general wellbeing. Many patients report improved daily energy, fewer respiratory infections and the disappearance of morning tiredness.
Among the most notable advantages:
A significant improvement in nasal airflow
Less snoring and better rest at night
Less reliance on nasal decongestants
Fewer episodes of sinusitis or rhinitis
Greater lung capacity during physical activity
Combined with cosmetic surgery, results that are both harmonious and functional
At the Instituto de Cirugía Plástica del Mediterráneo we combine a precise surgical approach with a complete functional assessment. Our team has extensive experience in functional rhinoplasty. The result depends on each patient’s anatomy and history, and is assessed case by case.
We work from a medical perspective, but a human one too. We know that behind every blocked nose there are daily discomforts that affect emotional, physical and social wellbeing. That is why every operation is planned on the basis of a rigorous diagnosis and carried out with the greatest safety, technology and individual care.
When to seek advice
If you have been breathing through your mouth for some time, if decongestants no longer work, or if you feel your nose is not working as it should, it may be time for a specialist assessment. Functional rhinoplasty is a well-established surgical option for nasal obstruction of anatomical origin; whether it is indicated is established after an individual assessment.
Surgery that is well indicated and properly carried out can appreciably improve nasal breathing and, with it, sleep.
Request an assessment at our clinic and start breathing better. We are here to help.
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What is the difference between functional and cosmetic rhinoplasty?
The functional one corrects the internal structures that obstruct the flow of air; its aim is not to change the external shape of the nose. The cosmetic one seeks to improve the appearance. Both can be combined in a single operation.
What exactly does it correct?
A deviated nasal septum, hypertrophy of the inferior turbinates, collapse of the nasal valves, the after-effects of injury, and congenital or acquired malformations.
“I can’t breathe through my nose.” Is it always the same thing?
No. The air can meet three different narrowings: a deviated septum that reduces one side, an enlarged inferior turbinate taking up space, or a nasal valve that collapses on breathing in — the narrowest point of the whole nose. They can coexist, and which one predominates is what decides the technique: septoplasty, turbinoplasty or valve reinforcement.
What symptoms suggest an anatomical obstruction?
Persistent nasal congestion, especially on one side only, mouth breathing above all at night, snoring or mild apnoea, headache associated with the effort of breathing, a reduced sense of smell, a feeling of breathlessness on exercise, and repeated upper respiratory infections.
How is the diagnosis confirmed?
Those symptoms can have various causes. It is the examination of the inside of the nose by rhinoscopy or nasal endoscopy that confirms the obstruction is anatomical. That is why it is not a preliminary formality: it is what determines the operation.
What is a septoplasty?
The correction of a deviated septum, the plate of cartilage and bone that divides the nose into two cavities. It is reached through internal incisions, repositioned, and the excess cartilage or bone blocking the airflow is removed, without changing the external shape unless a cosmetic correction is also requested.
What is it completed with?
According to the structures affected: turbinoplasty — reducing the size of the turbinates — reconstruction of the nasal valves when they collapse on breathing in, and structural grafts to reinforce weak areas.
How long does it take and does it leave a scar?
It is carried out in theatre under general anaesthetic and takes between 2 and 3 hours, depending on the structures involved and whether it is combined with a cosmetic rhinoplasty. Closing the incisions leaves no visible scars.
How long does recovery take?
Patients return to their normal routine between 5 and 7 days, and the splints and packing are removed at the clinic after a few days. The improvement in breathing is progressive: by around three months most patients breathe freely.
What is normal in the first few days?
A feeling of nasal congestion, swelling of the face, secretions or small amounts of bleeding, and discomfort from breathing through the mouth. You must not blow your nose, avoid physical effort, not sleep face down and stay away from dry or very polluted environments.
What is gained besides breathing better?
Breathing well affects sleep quality, physical performance, concentration and general wellbeing: less snoring and better rest at night, less dependence on decongestants, fewer episodes of sinusitis or rhinitis, and greater lung capacity during exercise.
Sources and clinical review
Murthy VA, Reddy RR, Pragadeeswaran K. Internal Nasal Valve and Its Significance. Indian Journal of Otolaryngology and Head & Neck Surgery, 2013. PMC3738809. The internal nasal valve as the narrowest segment of the nasal passage, bounded by the caudal edge of the upper lateral cartilage, the septum and the head of the inferior turbinate.
Anatomy, Head and Neck, Nose. StatPearls, NCBI Bookshelf. NBK532870. The anatomy of the septum, the turbinates and the nasal airway on which the description of the causes of obstruction rests.
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