"I want to reshape my nose, but I'm worried that breathing might become difficult after surgery"—many people have such concerns.
In fact,Rhinoplasty (Rhinoplasty) is not merely a cosmetic procedure; it is inseparable from respiratory function.
The latest guideline (2017) from the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNSF) defines nasal plastic surgery as "surgery that modifies the nasal form while maintaining or enhancing the nasal airway."
This article introduces medically evidence-based knowledge for achieving both aesthetic form and function.
Our clinicColumn listalso provides related information. Please refer to it.
Important preoperative step: Expectation management and risk screening
To achieve safe and ethical surgery, trustworthy clinics conduct rigorous preoperative evaluation for all patients (age 15 and over).
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 evaluation (BDD screening)
Body Dysmorphic Disorder (BDD)screening is a mandatory assessment item.
BDD is a mental disorder characterized by obsession with minor flaws in appearance; in such cases, psychological support takes priority over surgery.
Physical evaluation (OSA/obstructive sleep apnea confirmation)
When obstructive sleep apnea (OSA) is present, the risk of breathing obstruction from postoperative nasal packing and the timing of resuming CPAP therapy become important considerations.
Many specialists recommend temporarily discontinuing CPAP for 1–2 weeks postoperatively to allow tissue stabilization.
"Protecting respiration" anatomical evaluation: Internal and external nasal valves
Accurate assessment of the "valve" structures that determine nasal airflow greatly influences postoperative satisfaction.
According to reports by Burstein (2008) and others, the rate of internal nasal valve dysfunction following rhinoplasty is 25%, while the external nasal valve reaches 85%,precise evaluation 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 support structure.
External Nasal Valve
A support structure formed by the lower lateral nasal cartilage (LLC). When the LLC is weakened, the nasal ala may collapse during inhalation, potentially causing 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 conventional Cottle maneuver, a dynamic examination using a cotton-tipped applicator to lift specific areas and simulate the effect of a spreader graft is essential.
For details,please also see our Treatments list.
Latest Surgical Concept: Volumetric Rhinoplasty
In reduction rhinoplasty, the concept of "Volumetric Rhinoplasty" proposed by Kamburoglu (2021) has become the standard for current functional rhinoplasty.
Concept—Simultaneous Design of Morphologic Reduction and Volume Adjustment
When the external appearance of the nose is reduced, the internal volume inevitably decreases as well. Therefore, "volume adjustment" that optimizes internal airflow in accordance with morphologic changes becomes essential.
Three Essential Steps
Step 1: Examination and MeasurementUsing endoscopy and CT imaging, we perform detailed evaluation of bullous middle concha and posterior nasal septum deviation.
Step 2: PreventionWe avoid excessive mucosal repositioning andSpreader Flapmaintain the internal nasal valve angle.
Step 3: TreatmentWe combine radiofrequency-assisted inferior turbinate ablation, lateralization, and submucosal bone resection to establish a physical airway.
Latest perspectives on Webster's Triangle
Traditionally, during nasal boneosteotomyprocedures, preservation of the triangular bone at the pyriform aperture margin (Webster's Triangle) has been dogmatic.
However, recent evidence demonstrates that by performing appropriate inferior turbinate reduction and internal nasal valve reinforcement,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 carries risks of antibiotic-resistant bacteria, as well as potential adverse effects such as Clostridium difficile colitis, severe skin reactions, and gastrointestinal disorders.
Regarding nasal packing
Routine use is not recommended as it causes discomfort and airway obstruction. Particularly in OSA patients, it is important to minimize packing to prevent oxygen desaturation.
Regarding steroids
Systemic administration to reduce postoperative edema (swelling) and ecchymosis is recognized as an effective 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: Pursuing 12-month satisfaction
A minimum of12 months of follow-upis necessary until the final form of rhinoplasty stabilizes and internal tissues biologically settle.
We fully understand that this waiting period can be psychologically burdensome for patients. However, it is a biologically essential process for tissue stability.
At the 12-month postoperative mark, recording not only aesthetic 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 form and function in harmony.
- Rhinoplasty is surgery that simultaneously designs appearance and breathing function; preoperative evaluation determines success or failure
- There is risk of postoperative functional impairment in the internal nasal valve (25%) and external nasal valve (85%), making preoperative diagnosis essential
- Based on the Volumetric Rhinoplasty concept, it is important to adjust airway volume simultaneously with reduction
- Unnecessary antibiotic administration and nasal packing are not recommended; evidence-based postoperative management is required
- Final assessment should be 12 months or more postoperatively—with long-term satisfaction as the goal
At Zetith Beauty Clinic, we provide rhinoplasty prioritizing the achievement of both form and function.
We perform detailed preoperative evaluation using endoscopy and CT imaging and propose an optimal surgical plan customized for each patient.
If you are concerned about breathing impact, or if you feel discomfort following surgery at another clinic, please first consult us at afree consultation.
Author of this article
Hiromitsu NakamuraPhysician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
With research presentation records at domestic and international academic conferences, he is involved in technical guidance and education across Zetith Beauty Clinic. Specializing in precision rhinoplasty based on anatomical evidence, he pursues natural results tailored to each individual's skeletal structure and tissues.
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