While a nose that looks good brings balance and harmony to the face, it should not be at the sacrifice of breathing. Patent and functional nasal passages are a vital part the nose. The inside of the nose should be as nice as the outside. Often many Plastic Surgeons have very little to no training on functional nasal surgery so even if they happen to create a cosmetically appealing nose, they may neglect to fix the inside or worse yet, create new problems on the inside of the nose.
The inside of the nose and the outside of the nose are intimately connected. The nasal septum on the inside is the structural wall and foundation of the external nasal architecture. Think of the nose as a building. The septum is the support inner wall while the outside of the nose is roof. You cannot have a straight roof with crooked walls! Therefore is a naïve Plastic Surgeon fails to recognize or diagnose a deviated septum prior to Rhinoplasty, then he may actually create or worsen the appearance of a crooked nose. The old saying amongst Facial Plastic Surgeons is “Where goes the septum, so goes the nose!”
While the septum provides a source of cartilage for grafts during Rhinoplasty, its own structure is important. A crooked septum often must be straightened during a cosmetic Rhinoplasty. However, not all patients have a deviated septum. Slight deviations are very common and perfectly straight septums are rare. Often patients wonder is insurance will cover some or all of the Rhinoplasty if there is septal deviation. In most situations, the two parts of the procedure are billed separately. A cosmetic Rhinoplasty is not billed to insurance. Insurance may cover a small portion of the surgeon’s fee as well as part of the anesthesia and hospital fees. But ethically and legally the cosmetic portion should not be billed to insurance. However if there is a true and problematic septal deformity then insurance should hopefully cover that portion of the surgery. Enlarged turbinates may also create nasal airway obstruction. Turbinates are the humidifiers of the nose and they fluctuate in size during the day. They even alternate from side to side in a process called the “nasal cycle.” While the turbinates may be trimmed, they should not be over aggressively reduced or completely removed. This type of aggressive turbinate reduction, commonly done in the past, leads to atrophic rhinitis also known as empty nose syndrome. It’s quite a problematic functional internal nasal deformity that is not easily fixable.
Vestibuloplasty also known as spreader grafts can widen the internal valve area just above the nasal tip and below the nasal bones and improve nasal airflow. Alarplasty with alar rim grafts or alar batten grafts can provide strength and support to the nostrils and lessen or prevent dynamic inspirational nasal collapse.
Nasal reconstruction is more for reconstruction of the nose after MOHS skin cancer removal or trauma resulting in nasal tissue loss. Various techniques can be used including local and regional flaps. Some are done in one stage while others may require several surgeries for optimal results.