Is simultaneous resolution of 'nasal congestion' and 'low nose' possible? Key points patients with deviated septum should know
Did you know that nose surgery may help improve nasal congestion?
- Why combined treatment of deviated septum and cosmetic rhinoplasty is considered
- Approach to combined treatment to achieve both function (breathing) and aesthetic appearance
- What research data shows regarding post-operative symptom improvement
"I want a beautiful nose, but I've always had rhinitis and nasal congestion, so I'm worried about surgery…" Many people struggle with this concern.
Do you think "deviated septum should be treated by an ENT doctor"? Actually, cosmetic surgery also offers important approaches.
One of the most common questions at consultation is this: "Doctor, I want to raise my nasal bridge, but I've had chronic nasal congestion. Can cosmetic surgery fix both at the same time?"
Deviated septum (びちゅうかくわんきょくしょう) refers to a condition where the wall that separates the left and right nasal cavitiesthe nasal septum (びちゅうかく: the cartilage and bone wall deep in the nose)is significantly curved. When imbalance in growth speed between bone and cartilage during development, or minor trauma in childhood causes distortion of this wall, the airway narrows and may cause chronic nasal congestion.
Many people tend to think "nasal congestion = ENT disease," but the function (breathing) and form (appearance) of the nose are two sides of the same coin. When the nasal septum is curved, it may affect the external appearance of the curved nose (deviated nose) or asymmetry of the nasal tip.
Furthermore, when one nasal cavity (びくう: nasal passage) becomes narrow, the inferior turbinate (かびこうかい: the fold on the lateral wall of the nose that regulates air temperature and humidity) on the other side may compensatorily enlarge, resulting in a vicious cycle where both nostrils become congested. As mouth breathing becomes habitual, it may affect overall health status, including reduced sleep quality and throat dryness.
For this reason, when cosmetic surgery is used to refine the appearance of the nose, this internal distortion is sometimes taken into account. Deviated septum, a functional disorder, and cosmetic rhinoplasty should be comprehensively approached after thorough consultation with your physician.
"So, can it be done all at once?"
Treatment of deviated septum and cosmetic rhinoplastymay be considered for combined use depending on the patient's condition, but the indication varies greatly among individuals and requires careful judgment by the physician[1].
An approach to simultaneously solve the functional and cosmetic problems of the nose is medically termed "functional septorhinoplasty," and numerous studies have been conducted worldwide[2].
Nasal septum surgery (septoplasty) by ENT specialists and cosmetic rhinoplasty by cosmetic surgeons have different characteristics. ENT surgery primarily aims at functional improvement and typically removes the curved nasal septal cartilage, but in cosmetic surgery, this cartilage can sometimes be utilized as a material to raise the nasal tip or reshape it.
However, revision surgery (secondary rhinoplasty) performed after using cartilage as graft material may require harvesting costal cartilage (ろくなんこつ: cartilage from the ribs), which may increase the physical burden.
Additionally, the nasal septal cartilage serves as a "pillar" that supports the weight of the entire nose. Excessive removal of this pillar has been reported to cause deformity called saddle nose (鞍鼻), or reduce the strength of the nose.
Since both treatment methods have merits and demerits, it is important to comprehensively evaluate the patient's symptoms, wishes, and overall health condition and consult thoroughly with the physician. Please understand that results vary among individuals and the expected outcome may not always be achieved.
Post-operative score improvement? What research data shows about the possibility of functional improvement
While internet reviews sometimes mention unverified claims such as "the nose's function worsens when combined with cosmetic surgery," medical literature reports that symptom improvement may be expected in some cases[3].
In multiple studies, cases that underwent specific revision procedures have been examined for trends in improvement of nasal obstruction symptoms and objective evaluations regarding post-operative respiratory function[3].
However, these research results are reports from limited case numbers, and similar effects cannot be guaranteed for all patients. Individual variation is extremely large, and results differ significantly depending on the severity of symptoms and surgical method. Furthermore, surgery carries risks including infection, bleeding, scar formation, nasal shape change, and olfactory disorder.
When considering treatment, please fully understand these risks and expected benefits and consult well with a specialist. Please note in advance that results vary among individuals and improvement is not guaranteed.
Is the "septum" the key to straightening a curved nose (deviated nose)?
In the correction of a curved nose (deviated nose), even if the nose appears straight and beautiful immediately after surgery, there are cases where the nose becomes curved again as time passes – after half a year or a year. This is caused by the "memory" of the cartilage and tissues composing the nose to return to their original shape, and contracture (scar contracture: はんこんしゅうしゅく) during the healing process of internal scars.
In research in the field of plastic surgery, there is a view that states, "the key to a straight nose is a straight septum [4]."
Superficial cartilage grafting or simply shaving away a small amount of bone may not address the underlying cause—the deviated nasal septum—or the intrinsic and extrinsic forces pulling on it (such as tension from muscles and ligaments).
By addressing the nasal septum via open approach (a surgical method in which the columella—the pillar between the nostrils—is incised to allow direct visualization of internal structures), and by reinforcing and expanding the internal valve (the narrow area within the nasal cavity with the greatest airflow resistance) using techniques such as spreader grafts (cartilage inserted between the septum and lateral cartilage) or battens (cartilage grafts to prevent lateral wall collapse) as needed, improvements in appearance and ease of breathing may be expected. However, results vary from individual to individual, and complete correction may be difficult in some cases.
Research examining various approaches to correcting a deviated nose has demonstrated the importance of selecting treatment based on each patient's condition, and it has been reported that satisfactory results are not necessarily achieved in all Before-after cases [4].
But the situation is not that simple.
To achieve both improvement of deviated nasal septum and cosmetic nose reshaping, the choice of clinic and surgeon greatly influences the outcome.
Nasal surgery accompanied by functional impairment is not merely a cosmetic procedure but rather "reconstructive septorhinoplasty," which requires an extremely sophisticated approach and comprehensive diagnostic capability.
For example, within the nose there is a subtle but critical region called the "nasal valve (nasal valve: internal nasal valve and external nasal valve)" that regulates air resistance. When performing surgery for deviated nasal septum, if cartilage is excessively removed or manipulated without understanding the biomechanical structure of this nasal valve, the lateral nasal wall may collapse inward during inhalation, potentially worsening nasal breathing (nasal valve stenosis).
For this reason, when selecting a clinic, it is important not only to evaluate the superficial aesthetic design, but alsoto assess the functional aspects based on medical evidence (evidence-based medicine)—this becomes a crucial criterion for your decision.
During your pre-operative consultation, check not only for palpation and visual inspection, but also whether the doctor provides accurate anatomical explanations regarding the internal structure (such as the degree of nasal septum deviation, presence of turbinate hypertrophy, and nasal valve strength). To achieve both function and beauty, diagnostic ability to accurately interpret your nasal structure is the most important factor. However, please understand that even physicians with the highest level of skill cannot guarantee complete functional improvement or aesthetic results.
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Summary of this article
Finally, let me summarize the key points of this article.
- Treatment of deviated nasal septum (functional improvement) and cosmetic rhinoplasty (aesthetic enhancement) may be considered simultaneously depending on the patient's condition, with the advantage of effective cartilage utilization; however, careful individual assessment of applicability is necessary.
- While nasal congestion improvement may be expected with appropriate surgery, results vary greatly among individuals, improvement is not guaranteed, and risks are involved.
- For fundamental improvement of deviated nose (crooked nose), an approach to the nasal septum foundation is considered important in addition to surface adjustment; however, complete correction is often difficult.
- Balancing function (breathing) and appearance (aesthetics) requires comprehensive evaluation by a physician with detailed anatomical knowledge of nasal structures and high surgical skill; please understand that all treatments have limitations.
If you have any concerns, please feel free to contact us. Zetith Beauty Clinic provides counseling based on medical evidence.
References
- Brown S, Brown T, Rohrich R. Clinical Applications of Tranexamic Acid in Plastic and Reconstructive Surgery. Plastic & Reconstructive Surgery. 2024 (DOI)
- Ishii L, Tollefson T, Basura G, et al. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty Executive Summary. Otolaryngology–Head and Neck Surgery. 2017 (DOI)
Author of this article
Tetsu AkiraPhysician
Director, Medical Corporation SUNSET — Zetith Beauty Clinic Ginza, Osaka, Fukuoka
Specializing in anatomically-based rhinoplasty with annual case numbers among the industry's top tier. Known for surgical design emphasizing structural support and an approach pursuing long-term stability.