"I want to reshape my nose, but I'm concerned that breathing may become difficult after surgery"——many people harbor such concerns.
In fact,Rhinoplasty is not merely a cosmetic procedure, but an inseparable surgery from respiratory function.
According to the latest guidelines (2017) from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF), rhinoplasty is defined as "surgery that modifies nasal form while maintaining or enhancing nasal airway."
This article introduces medical evidence-based knowledge for achieving both form and function.
Our clinicColumn listalso provides related information. Please refer to it.
Critical preoperative step: Expectation management and risk screening
To realize safe and ethical surgery, reputable clinics conduct rigorous preoperative assessment on all patients (age 15 and above).
Expectation Management
It is important to carefully confirm the patient's motivation and share medically achievable goals and limitations.
Detailed documentation of this discussion in the medical record is an essential process from the perspective of medical safety and ethics.
Psychological assessment (BDD screening)
Body Dysmorphic Disorder (BDD)screening is an essential assessment item.
BDD is a psychiatric disorder characterized by obsession with minor physical flaws; in such cases, psychological support takes priority over surgery.
Physical assessment (OSA / Obstructive Sleep Apnea confirmation)
When obstructive sleep apnea (OSA) is present, the risk of respiratory obstruction from postoperative nasal packing and the timing of resuming CPAP therapy become important.
Many specialists recommend pausing CPAP use for 1–2 weeks postoperatively to allow tissue stabilization.
"Protecting respiration" anatomical assessment: Internal and external nasal valves
Precise evaluation of the "valve" structure that determines nasal airflow significantly impacts postoperative satisfaction.
According to reports by Burstein (2008) and colleagues, malfunction of the internal nasal valve occurs in 25% of cases following rhinoplasty, and external nasal valve in 85%,precise assessment to prevent iatrogenic respiratory obstructionis essential.
Internal Nasal Valve
The narrowest region within the nasal cavity, formed by the upper lateral nasal cartilage, nasal septum, and inferior turbinate.
To prevent stenosis in this area,Spreader Graftis used to reconstruct and reinforce the supporting structure.
External Nasal Valve
The supporting structure formed by the lower lateral cartilage (LLC). When the LLC is weak, nasal ala collapse during inspiration can occur, leading to severe respiratory difficulty.
Therefore,Columellar Strutand other grafts are positioned to ensure support at the nasal tip.
Preoperative diagnosis in practice——Cotton-tipped applicator test
In preoperative diagnosis, in addition to the traditional cotton test (Cottle maneuver), dynamic testing using a cotton swab to lift specific areas and simulate the effect of a Spreader Graft is essential.
For details, please seeour Treatments list.
Latest surgical concept: Volumetric Rhinoplasty
In reductive nasal surgery, the concept of "Volumetric Rhinoplasty" proposed by Kamburoglu (2021) has become the standard for contemporary functional rhinoplasty.
Concept——Simultaneous design of morphological reduction and volume adjustment
When the external appearance of the nose is reduced, internal volume inevitably decreases. Therefore, "volume adjustment" that optimizes internal airflow in accordance with morphological changes becomes essential.
Three essential steps
Step 1: Examination and measurementWe perform detailed examination using endoscopy and CT to assess bullous middle concha and posterior nasal septal deviation.
Step 2: PreventionWe avoid excessive mucosal repositioning andSpreader Flapto maintain the internal nasal valve angle.
Step 3: TreatmentWe combine radiofrequency-assisted inferior turbinate ablation, Lateralization, and submucous bone resection to secure adequate physical airway.
Latest perspectives on Webster's Triangle
Traditionally, during nasal boneosteotomyprocedures, the triangular bone at the pyriform aperture margin (Webster's Triangle) has been considered inviolable dogma.
Conversely, recent evidence demonstrates that by performing appropriate inferior turbinate reduction and reinforcement of the internal nasal valve,low-to-low osteotomycan be safely completed without compromising airway function.
Evidence-based postoperative management: What is necessary and what is not
The AAO-HNSF Guideline (2017) provides direction to eliminate unnecessary procedures and maximize patient safety.
Regarding antibiotics
Routine administration beyond 24 hours postoperatively is not recommended. Unnecessary prolonged use risks antibiotic-resistant bacteria, as well as adverse effects including Clostridium difficile colitis, serious dermatological reactions, and gastrointestinal disturbances.
Regarding nasal packing
Routine use is not recommended due to discomfort and airway obstruction. Particularly in OSA patients, it is important to minimize packing to prevent oxygen saturation decline.
Regarding steroids
Systemic administration to reduce postoperative edema (swelling) and ecchymosis is recognized as a valid option. It is used appropriately based on the attending physician's judgment.
For the latest evidence on postoperative management, please also refer torelated literature on PubMed (Functional Rhinoplasty).
Conclusion: Aiming for satisfaction at 12 months post-op
Until the final form of rhinoplasty stabilizes and internal tissues become biologically settled, a minimum of12 months of follow-up observationis necessary.
We fully understand that this waiting period is a time of significant psychological burden for patients. However, it is a biologically essential process for tissue stabilization.
At the 12-month post-op mark, recording not only morphological beauty but also functional satisfaction (ease of breathing) in detail, and having both physician and patient evaluate together, is the path to "true success" with harmonized form and function.
- Rhinoplasty is surgery that designs both appearance and breathing function simultaneously, and pre-operative assessment determines success or failure
- There is a risk of post-operative functional disorder in the internal nasal valve (25%) and external nasal valve (85%), making pre-operative diagnosis essential
- Based on the concept of Volumetric Rhinoplasty, it is important to adjust airway volume simultaneously with reduction
- Unnecessary antibiotic administration and nasal packing are not recommended, and evidence-based post-operative management is required
- Final evaluation should be 12 months or more post-op — setting satisfaction goals from a long-term perspective
At Zetith Beauty Clinic, we provide rhinoplasty that prioritizes both form and function.
We perform detailed pre-operative evaluation using endoscopy and CT, and propose the optimal surgical plan for each patient.
If you are concerned about the impact on breathing, or if you feel discomfort after surgery at another clinic, please firstfree consultationfor a consultation.
About the author of this article
Hiromitsu NakamuraPhysician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
With a track record of research presentations at domestic and international academic conferences, also involved in technical instruction and education for Zetith Beauty Clinic as a whole. Specializes in precision rhinoplasty based on anatomical evidence, pursuing natural results tailored to each individual's bone structure and tissues.
If you're thinking "What about my case?"
Book a free consultation
We do not engage in any pushy sales pitches. Feel free to contact us.