Rhinoplasty and Nasal Blockage

Nose Job for Blocked Breathing?

Many people with blocked nasal passages and troubled breathing don’t realize their breathing is blocked until they have a nose job. After all, blocked breathing is nothing new to them; they have always breathed that way.  These same patients also usually snore at night like our pal, above.

Then, during a rhinoplasty or some other cosmetic nasal surgery, the cosmetic plastic surgeon finds that the inside of the nose needs some corrective surgery that is causing the blocked breathing.

Of course, during the cosmetic surgery is not the time to make an assessment of the patient’s breathing, right?  The time to completely evaluate the nose is at the first doctor-patient consultation. It’s like before leaving for a long car trip: besides filling up with gas, you check under the hood.

Before any rhinoplasty surgery, the plastic surgeon should check two critical inside-the-nose structures:

• The septum, the thin wall that divides the nostrils
• The turbinates, structures farther up in the nose that can swell

A septum can become bent or twisted at birth, injured in an accident or during the heat of sports.

(Read more about surgical repair of a deviated septum  or surgical turbinate reduction)

If the septum is bent or twisted or if the turbinates are swollen, that changes the architecture of the nose, making the interior nasal passages narrower and thus harder for the patient to breathe.

To get a better idea, the surgeon must figure out how much air normally passes through the patient’s nose.

One way to do that is asking the patient – with the mouth firmly sealed — to breathe through only one nostril and then the other. If the breathing is noisy in either nostril, there may be a blockage up inside the nose.

Nasal blockages may also be caused by:

• Polyps
• Non-cancerous growths
• Nasal allergies like hay fever

So one or all of the above can cause the turbinates and entire nasal lining to swell and thus reduce air flow to the lungs.

For the Beverly Hills cosmetic plastic surgeon who does many nose jobs, the dead-bang giveaway sign of blocked nasal passages is when a patient reports:

• “I have four or five sinus infections yearly.”
• “Every time I have a cold, it goes into my sinuses. I am miserable when that happens.”

Actually, true sinusitis, while rare, requires an X-ray to confirm the diagnosis and antibiotics for treatment.

Moreover, real sinusitis causes serious symptoms, including:

• Pain in the cheeks
• A high fever
• Pain around the eyes and forehead
• Often, a foul discharge dripping down into the throat

There is often confusion for patients about what is actual sinusitis or sinus infections.

In the normal state, clear nasal passages allow for airflow to and into the sinuses, which are small hollow chambers, inside the skull.

But with the blockages in the nose, come pressure and a boring sensation deep inside the head. That may be due only to failure of air to enter the sinuses.

The headache-like sensation is known as a vacuum headache because the nasal blockage, preventing air from entering the sinuses, causes a negative pressure and the vacuum within the sinuses.

However, a condition in which the internal nasal blockage causes headaches, stuffiness and other discomfort is far more common than a case of true sinusitis which is a far more serious condition.

Other likely candidates for blocked nasal passages and breathing troubles are:

• Uncorrected broken noses, usually with a deviated septum
• Nasal drainage problems
• Allergies. Turbinates and nasal linings can swell in response to certain substances like dust, plant pollens, mold or hay fever.
• Those who use CPAP (continuous positive air pressure) machines to stop snoring
• Cigarette smokers

A CPAP machine forces air under higher pressure into the nose and down into the lungs.  The machine is often prescribed after testing the sleeping patient in a sleep lab to stop problem snoring.

Basically, a snoring patient is one who does not breathe well at night. That results in a sleepy, poorly performing person during the next day. The lack of oxygen from poor sleep affects every organ in the body.

Sleeping with a CPAP

Surgery to correct a deviated septum or swollen turbinates can be combined with a cosmetic rhinoplasty that creates a nose with a more pleasing appearance, and one that flatters the face.

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