Function or form
When it comes to spring, the thought of warmer weather, budding plants and a chance to enjoy the outdoors sounds great for a lot of people. But for those who are suffering from seasonal allergy symptoms, it may be another story.
In their case, finding relief for difficulty breathing brought on by allergies can become a priority and may even lead them to a facial plastic surgeon for rhinoplasty.
Although often thought of as a cosmetic procedure for the nose to alter a patient’s appearance, the “primary goal of a functional rhinoplasty is to improve breathing through the nose when there is a structural problem causing nasal obstruction,” says Washington University facial plastic surgeon Dr. Emily Spataro, “Not to address other issues such as nasal drainage, sinusitis, headaches, snoring or other nasal complaints.”
When Dr. Spataro or one of her colleagues, Dr. Gregory Branham or Dr. John Chi of the Washington University Facial Plastic Surgery Center, meet with patients concerning a nasal obstruction, there are two components of nasal breathing they discuss — mucosal and anatomic obstruction.
“Mucosal obstruction involves swelling or inflammation of the mucosal linings of the nose. This can either be from allergies, allergic rhinitis, or from generalized inflammation, non-allergic rhinitis. These causes are best treated with medications such as nasal sprays or evaluation by an allergist if there is concern for allergic rhinitis,” Dr. Spataro explains. “The other component is an anatomic obstruction, which involves issues such as a deviated septum, enlargement of the inferior turbinates (structures inside the nose that help regulate airflow), or narrowing of the internal nasal valve, which is an area of the nose where most resistance to airflow occurs.”
Patients may have one or both of these components contributing to their nasal obstruction, and it is often multifactorial.
For instance, if an anatomic obstruction were found during an exam, then surgical procedures to address this would be either a septoplasty (a procedure for a deviated septum) or a functional rhinoplasty, depending on the location of the obstruction.
But patients with concurrent rhinitis may find that their medications work better or they are more able to tolerate times of increased allergens when their anatomic obstruction is improved with surgery, even if they still have to deal with allergies or inflammation.
Evaluation is the first step
It is recommended for patients who want to learn more about these procedures to first undergo an evaluation by an otolaryngologist or a facial plastic surgeon, such as Drs. Spataro, Branham or Chi, who specifically perform surgery for nasal airway obstruction.
Often for insurance to cover a surgical procedure, a patient must “fail” medical management first, Dr. Spataro says.
“This means they have demonstrated consistent use of a nasal steroid spray with no or minimal improvement of symptoms. If the patient has not previously been on a nasal steroid medication, then the provider will recommend a trial of these, followed by re-evaluation about six weeks later,” she says. “If patients are found to have an anatomic obstruction and have previously found no benefit from nasal medications or allergy treatments, then a surgical procedure is discussed.”
The exact procedure depends on the specific patient’s site of anatomic obstruction. Insurance generally does cover these procedures if no cosmetic changes are made to the nose. Cosmetic changes can be made at the same time as functional rhinoplasty; however, this will be an out-of-pocket expense for the patient.
What to expect
A functional rhinoplasty is generally an outpatient procedure, meaning patients can go home the same day and the procedure is performed under general anesthesia. It can average anywhere from 1.5 to more than 3 hours, depending on the specific surgery being performed.
Most patients are advised to take the next week off of work or school and return a week later for a post-operative visit. There are light activity restrictions for a total of two to three weeks after surgery and contact sport precautions for about six weeks after surgery.
“Depending on the procedure, the nose may be more swollen for the first six weeks after surgery, although changes to the nose can occur up to a year following the procedure,” Dr. Spataro adds. “Therefore, we follow patients for at least a year after their surgery.”
For more information or to schedule a consultation with the physicians at the Facial Plastic Surgery Center, call 314-996-3880 or click here.