When is a rhinoplasty medically necessary? 

Most people think of the words “rhinoplasty” and “nose job” as one in the same.  However, while a “nose job” is really a term that is used to refer to a cosmetic procedure performed on the nose to improve the appearance, “rhinoplasty” is a broader term and refers to any surgery that is done to alter the structure of the nose for appearance purposes, breathing purposes, or both.  A “functional rhinoplasty” is surgery that focuses on optimizing the structure of the nose to improve breathing.  While there may be some mild changes in nasal appearance that occur whenever the structure of the nose is manipulated, this procedure is not done for cosmetic reasons.  Most insurance providers have strict guidelines for covering procedures such as this. 

A functional rhinoplasty is typically considered medically necessary if one or both of the following criteria are met:

  1. when a patient has a complaint of nasal obstruction affecting their breathing that is unrelieved by the use of a nasal steroid spray for at least 4-6 continuous weeks and there is an anatomic issue with the nose to which this obstruction can be at least partially attributed
  2.  there is a history of nasal trauma, a visible nasal deformity, and a CT scan that demonstrates a fracture as the likely explanation for the deformity

Patients who have an anatomic issue contributing to their nasal obstruction may show some improvement in breathing with increased nasal support by applying the “modified cottle maneuver.”  In the office, I perform this maneuver by gently lifting the sidewall of the nose away from the midline.  At home, patients can wear a Breathe Right strip to get a similar effect.  A deviated septum is another common anatomical cause of nasal obstruction (look at my page on “septoplasty”).  During our consultation, I will thoroughly evaluate each part of the nose to come up with the best plan of care for your nasal obstruction. 

Patients who undergo a functional rhinoplasty may see changes to their outward appearance. If a patient has an especially twisted or crooked nose, they may notice that the functional procedure to correct their breathing also makes the nose appear straighter.  In some cases, the nose may appear slightly larger or with more defined areas than before surgery, which can be due to cartilage grafts that are used to strengthen the nasal structure.  Some patients who are candidates for functional rhinoplasty surgery also have specific desires about the appearance of their noses.  In those cases, it is not uncommon to perform a functional and cosmetic rhinoplasty during the same surgery.

My training and experience as both a board-certified ENT and Facial Plastic Surgeon specializing in rhinoplasty gives me a unique and highly attuned perspective on the anatomy and appearance of the nose.  When deciding on your rhinoplasty surgeon, you should choose a specialist who deeply understands this delicate interplay between nasal form and function.


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