We all have that friend who, according to their doctor, “needed” a nose job, and then we have friends who simply wanted one. So, what’s the difference?
One of the few procedures that are common among men and women and performed from teenage years through adulthood, rhinoplasty (a.k.a. nose job, nose surgery, nasal surgery) can be classified as both a medically necessary plastic surgery procedure and an elective cosmetic surgery depending on how and why it is performed.
Generally speaking, your friend who “needed” the procedure likely had what is called a ‘functional’ rhinoplasty, during which a surgeon worked to resolve internal structural issues — in addition to potentially making aesthetic changes. Because the surgery was performed for medical reasons, it very well may have been covered by insurance (typical of plastic and reconstructive procedures but not cosmetic ones).
Your friend who wanted to change the shape, size, or appearance of her nose without an underlying medical condition, meanwhile, probably underwent what is known as a ‘cosmetic’ rhinoplasty. The cosmetic surgery procedure focuses exclusively on the external bone structure and usually requires patients to pay out of pocket.
According to the American Society of Plastic Surgeons, there were some 215,000 rhinoplasties performed in the U.S. in 2018 alone, and that statistic accounts for both functional and cosmetic procedures. If you’ve been considering a nasal surgery, here is a guide to the two classifications.
What Is a Functional Rhinoplasty?
First things first, a functional rhinoplasty is a medically necessary procedure that is used to correct breathing problems and sinus concerns. While we may not be able to see the inside of the nose, there can be structural issues that pose medical risks.
“The nose is the organ of breathing,” says Oren Friedman, MD, a Philadelphia-based board certified facial plastic surgeon and director of facial plastic surgery at the University of Pennsylvania. “We are meant to breathe through the nose and not the mouth.”
As Dr. Friedman explains, the most common reason a patient seeks a functional rhinoplasty is to improve breathing. Patients who have a deviated septum (i.e. a narrow or crooked nasal passage caused by genetics, accident, or trauma), for example, may require a septoplasty to straighten or repair the septum. Beyond correcting a deviated septum, a rhinoplasty can “strengthen the sidewalls of the nose, so that the nasal sidewalls do not collapse and, therefore, obstruct airflow when the patients breathe in,” he shares. For cases of congenital abnormalities of nasal anatomy (think: cleft lip nasal deformities), meanwhile, Dr. Friedman says “highly specialized surgical care of the nasal tip cartilages and skin” is required.
For patients dealing with intense allergies or sinus infections that cause the turbinates (i.e. small structures inside the nose that clean and humidify air that passes through) to swell, nasal surgery may be able provide relief.
There are three pairs of turbinates in each nose, and, when the lower set (read: inferior turbinates) become swollen, they can cause nasal obstruction and make it more difficult to breathe. To fix the structural issues, doctors may recommend a turbinate reduction. While non-surgical treatments, like radiofrequency, can sometimes do the trick, surgery might be needed.
“Some patients require septum straightening surgery as well as turbinate reductions, however, we generally advise against removing significant portions of nasal turbinate tissue,” Dr. Friedman warns. “Turbinate tissue is vital to the function of the nose — namely, humidifying, warming, and filtering the air are enhanced by the presence of turbinate tissue. Removal of too much turbinate tissue will lead to irreversible nasal problems. Ask your surgeon to not remove much or any turbinate tissue when you undergo nasal surgery.”
Whether performed individually or in tandem, both a septoplasty and turbinate reduction take six months to a year to heal. While improved breathing can be expected, turbinates will grow back in time and the septum may never be perfectly straight.
What Is a Cosmetic Rhinoplasty?
Cosmetic rhinoplasties, on the other hand, focus on the outside of the nose (i.e. the part of the nose you can visibly see). Typically, patients that undergo the cosmetic procedure are dissatisfied with the appearance of their nose. A rhinoplasty can be used to:
- Reshape and resize the nose
- Address crookedness and asymmetries
- Change the base or bridge of the nose (or both!)
- Conceal a hump or bump
- Correct a pinched or bulbous nasal tip
“The most common structural reasons for which patients seek cosmetic rhinoplasty include a prominent hump or bump along the bridge of the nose that they wish to be reduced, prominent and bulbous tip cartilages of the nose that they wish to be made smaller and triangulated, and a crooked nose that a person may wish to straighten out,” Dr. Friedman says. “The structural components that most often need to be altered, therefore, include the nasal bones as well as the tip cartilages.”
While the surgery is limited to the nose, the results can help to balance the entire face. At the end of the day, cosmetic rhinoplasty surgery isn’t a medical necessity, but it can boost confidence and make patients more comfortable with their appearance.
There are plenty of differences between a functional rhinoplasty and a cosmetic rhinoplasty, but at least one thing is true of each: the procedure improves a patient’s quality of life. While it may be easy to classify one as purely aesthetic and the other as medical, many rhinoplasty surgeries end up being a combination of the two.
“This is one of the most common procedures for specialized nasal surgeons, and it gives an opportunity for the surgeon to enhance a patient's quality of life on two different levels,” Dr. Friedman says of the combination surgery. “First, we are able to improve their quality of life through improvements to their appearance, and secondly we are able to improve their quality of life through improved nasal breathing.”
Regardless of the reasoning behind the rhinoplasty, the recovery and healing processes are similar — though there are subtle differences. “If the nasal bones need to be contoured in a cosmetic procedure, there will likely be some external bruising which would not be present if only internal nasal surgery was being performed,” Dr. Friedman notes. “Other than the slight bruising that might occur, the internal swelling of the nose generally resolved in one week for each of the different types of nasal surgery.”
At the end of the day, most people enjoy the results of their procedure by the six-month mark, but it can take up to a year for the nose to fully heal. Additionally, it is important to discuss with your surgeon whether or not your procedure is purely functional, purely cosmetic, or a hybrid because it will impact whether your insurance provider covers some part of the cost.
Regardless of which type of rhinoplasty you’re after, the procedure is best performed under the care and guidance of a specialized surgeon to avoid complications and the need for revisions down the road.
“Excellence in outcomes for these types of nasal surgeries relies on the surgeon's expertise in this highly sub-specialized field,” Dr. Friedman explains. “In order to avoid the need for revision rhinoplasty due to failure of the first operation, it is very important the patient make the extra effort to identify a plastic surgeon who specializes in both internal and external nasal surgery.”
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