When evaluating the aesthetics of the nose, I do not treat the airway as a separate issue. In functional rhinoplasty, the fundamental question is to understand which structure is causing the breathing difficulty and how the aesthetic plan will affect that structure.
The septum is the partition between the two nasal cavities. The nasal valve regions, on the other hand, are critical narrow passages through which air flows; these areas may exhibit persistent narrowing or inward movement during inhalation. The turbinates and the nasal mucosa can also affect the airway. Problems with these structures may occur simultaneously.
The presence of a deviated septum in a patient does not necessarily mean that all symptoms are caused solely by this condition. During the examination, the location of the obstruction, its changes over time, and any accompanying symptoms are evaluated. The decision to proceed with surgery must be based on these distinctions.
It is important to determine whether the complaint is unilateral or bilateral; whether it is constant or intermittent; and whether it is related to trauma or a previous surgery. The treatments the patient has undergone and any previous nasal procedures are also part of the treatment plan. When necessary, the intranasal evaluation is supplemented with other tests.
Photographs are valuable for aesthetic analysis; however, we cannot reliably assess a dynamic valve problem based solely on a photograph. The AAO-HNS report on the nasal valve also emphasizes the importance of history and physical examination. This resource is the supplementary professional reference I used for the functional distinctions on this page. [4]
The nasal ligaments and adjacent areas of cartilage are not merely passive tissues located beneath the aesthetic surface. In our 2012 study, we also addressed the relationship between management of the scroll region and the internal nasal valve. This is one of the reasons why I do not consider surgical dissection in isolation from function. [1]
In the functional approach, the goal is not merely to expand an area. It is also necessary to assess where support is needed and how the change in shape might affect the airway. The same technique can be applied in different ways depending on the specific anatomy.
The area where the lateral nasal wall and the tip cartilages meet is where the covering tissue and supporting structures converge. The article on the scroll flap that my colleagues and I published is a technical paper that addresses tissue management in this region under the headings of aesthetics, function, and healing. [2]
The fact that a technique was developed with these goals in mind does not mean that the same functional outcome will be achieved in all patients. For this reason, I do not substitute the published technique for the findings of the examination. What matters for the patient is the rationale for how the recommended procedure addresses their specific airway problem.
The nose is a mobile part of the face. Changes that occur during a smile may reveal relationships that are not visible in a still photograph. A study I co-authored on the levator labii alaeque nasi muscle and dorsal septum deviation examines how the muscle’s effect can be incorporated into deviation analysis. [3]
For this reason, the evaluation should not focus solely on a midline measured with a ruler; facial movement and the patient’s symptoms are also important. The degree of visible asymmetry may not always correspond to the severity of breathing difficulties.
Procedures involving the septum, valve support, and treatment of the turbinates address different issues. Performing one does not automatically mean the other will be resolved. The AAO-HNS statement also notes that septum or turbinate surgery is not a substitute for valve repair when it is necessary. [4]
When speaking with a patient, I make a point of describing aesthetic and functional goals separately, and then explaining how they will be integrated into the same treatment plan. Part of this discussion also involves explaining that there may be non-surgical causes of nasal obstruction and that not every complaint can be resolved with rhinoplasty.
You can access the relevant publications and book chapters via the links below. The scope of the studies and the applicability of each technique should be evaluated on a case-by-case basis.
Barış Çakır and colleagues · research article
Valerio Finocchi, Fernando Nakamura, Barış Çakır, Helena Hotz Arroyo Ramos · co-authored article
Ali Teoman Tellioğlu, Hülda Rifat Özakpınar, Barış Çakır, İbrahim Tekdemir · co-authored article
American Academy of Otolaryngology–Head and Neck Surgery · supplementary professional resource
A treatment plan is developed by taking into account your nasal anatomy, your breathing difficulties, and your expectations.
Frequently Asked Questions About Functional Rhinoplasty.
Septoplasty addresses septal issues. Functional rhinoplasty may also involve other structures that affect the airway, such as external supports and valve regions. When necessary, these procedures are planned together.
Yes. Problems with the internal structures or with the lateral wall support, which changes during breathing, may not be apparent from the external appearance. An external photograph is no substitute for an internal nasal examination.
A photograph can be helpful for an initial assessment. However, a clinical evaluation is necessary to assess valve movement, intranasal tissues, and the cause of the complaint. A definitive treatment plan should not be based solely on a photograph.
No. A response to medication alone is not an indication for surgery. Mucosal issues, structural narrowings, and other causes must be evaluated. A structural valve problem is not managed in the same way as inflammatory or allergic symptoms.
In appropriate cases, both objectives can be included in the same surgical plan. First, the source of the airway narrowing must be identified, and the relationship between the planned aesthetic changes and these structures must be evaluated.
No. The principle of tissue preservation does not mean that the existing narrowing is automatically resolved. A separate evaluation and a well-reasoned plan are required for the functional issue.
Yes. The previous procedure, the healing process, current support structures, and the internal structures of the nose are all evaluated together. It is not sufficient to plan a new cosmetic change without first determining the cause of the problem.
Changes in the patient’s symptoms, physical examination findings, and any functional assessments deemed necessary are considered together. A single photograph or aesthetic measurement does not reflect the full scope of respiratory function.
You can request an appointment to discuss your personal expectations and options.