Functional rhinoplasty: breathing and shape treated together.
A nose that looks balanced and a nose that breathes well depend on the same structures. Understand how septum, valves and turbinates are addressed in a single planned operation.
Functional rhinoplasty treats nasal breathing and nasal shape in the same operation. The surgeon corrects a deviated septum, narrow or collapsing nasal valves and enlarged turbinates, then reshapes the dorsum and tip using the repaired framework as support. Dr. Guilherme Sella is an ENT surgeon with RQE in Otorhinolaryngology and a doctorate from HCFMRP-USP, so airway anatomy and aesthetic planning are assessed in the same consultation. In Brazil, the functional portion is usually documented separately, which helps patients request reimbursement from their own health plan. Indication, risks and technique are defined individually.
What functional rhinoplasty means
Functional rhinoplasty is a single operation that addresses two things at once: how air moves through your nose and how your nose looks. The same cartilage and bone that shape the dorsum and the tip also form the walls of the airway. Narrow that airway and you get obstruction. Weaken it and you get collapse on inspiration.
Many patients arrive with a double complaint. They do not breathe well through one side, they snore, they wake up with a dry mouth, and they also dislike a hump or a drooping tip. Treating only one of those problems often means operating twice on the same structures.
A nose is a three dimensional airway with a skin cover. Shape and function share the same framework.
Why an ENT background changes the planning
Dr. Guilherme Sella trained in Otorhinolaryngology at the Hospital das Clinicas of the Ribeirao Preto Medical School, University of Sao Paulo, and completed a direct doctorate in Morphophysiology of Facial Structures at the same institution in 2018. He also holds certification from the European Board in Facial Plastic and Reconstructive Surgery and completed a structured rhinoplasty fellowship in Melbourne and Sydney.
What this means in practice is simple. The consultation includes an internal examination of the nose with an endoscope when indicated, not only external photographs. Septal deviation, valve behavior during inspiration, turbinate size and mucosal inflammation are documented before any discussion about the dorsum or the tip.
His published work in the Facial Plastic Surgery Clinics of North America and in Facial Plastic Surgery deals specifically with dorsal preservation and how to avoid complications, which is a technique family that interacts directly with the airway. He has also published on chronic rhinosinusitis and its recurrence factors, which is the other side of nasal obstruction.
The septum: the center of both problems
The septum is the vertical wall that divides the two nasal cavities. A deviation can block one side, push the nasal tip off center, and make the external nose look crooked. It is also the main source of grafting material in structural rhinoplasty.
Septoplasty inside a rhinoplasty is different from isolated septoplasty. The surgeon preserves an L shaped strut of cartilage for support, harvests what is needed for grafts, and corrects the deviation without weakening the nasal base. In revision cases where septal cartilage was already used, ear or rib cartilage may be required. Revision rhinoplasty is more complex and longer for this reason.
Nasal valves: where many breathing complaints actually live
Patients often say they have a deviated septum when the real limitation is the valve. There are two:
- Internal nasal valve: the narrowest point of the airway, between the upper lateral cartilage and the septum. Narrowing here causes constant obstruction that gets worse with effort.
- External nasal valve: the nostril rim and the lateral wall. Weak cartilage here collapses when you inhale deeply.
A poorly planned cosmetic rhinoplasty can narrow these valves. Aggressive hump removal, excessive narrowing of the bony vault and over resection of the lateral cartilages are classic causes of obstruction that appears months after surgery. Spreader grafts, spreader flaps, alar batten grafts and lateral crural repositioning are among the maneuvers used to open or support the valve.
| Symptom pattern | Likely structure involved | Common surgical approach |
|---|---|---|
| One side blocked all the time | Septal deviation | Septoplasty with cartilage preservation |
| Both sides blocked, worse at night or with allergy | Turbinate hypertrophy | Turbinoplasty with mucosa preservation |
| Nostril sidewall sucks in when you inhale | External valve collapse | Alar batten or lateral crural grafts |
| Pinched middle third, worse after previous surgery | Internal valve narrowing | Spreader grafts or spreader flaps |
| Obstruction plus facial pain, pressure, loss of smell | Sinus inflammation | Endoscopic sinus surgery evaluation |
Turbinates, allergy and what surgery does not solve
Turbinates are structures on the lateral wall that warm and humidify air. When chronically swollen by allergy, they obstruct both sides. Turbinoplasty reduces the volume while preserving the mucosa, since excessive resection can cause dryness and crusting.
Surgery corrects anatomy. It does not cure allergic rhinitis. Patients with allergy still need clinical treatment afterward, and this is explained during planning so expectations stay realistic.
Can preservation and ultrasonic techniques be used in functional cases
Yes, and this is a large part of the surgical planning discussion. Dorsal preservation rhinoplasty lowers the dorsum by removing cartilage or bone from below, keeping the natural dorsal roof and the keystone area intact. Because the upper lateral cartilages are not detached from the septum, the internal valve area is often disturbed less than in classic dorsal reduction.
Ultrasonic rhinoplasty uses a piezoelectric instrument that cuts bone while sparing soft tissue and mucosa. This allows more precise osteotomies and more controlled narrowing of the bony vault.
Neither technique fits every nose. Thick skin, previous surgery, severe deviation of the bony dorsum and large grafting needs all influence the choice. The decision is made case by case, and in selected situations high frequency dermatologic ultrasound is used before surgery to assess skin thickness, previous fillers, old grafts and columellar vascularization.
Surgery, hospital and recovery
The operation is performed under general anesthesia and usually takes three to five hours, longer in revision cases. Hospital stay is twelve to twenty four hours at a hospital structure in Maringa with adult intensive care and twenty four hour intensivists.
What to expect afterward:
- External splint for about seven days, then taping for roughly one more week.
- Nasal packing is avoided in most cases. A thin silicone splint may stay inside for about ten days when the septum was corrected.
- Light bleeding for forty eight to seventy two hours is expected. Periorbital bruising can last up to fifteen days.
- Saline irrigation from the first days. Never blow your nose.
- Head elevated at thirty degrees for at least ten days, ice in the first two weeks.
- Exercise after fifteen days, no glasses for four weeks, sun protection factor thirty for three months.
Breathing often feels worse before it feels better, because of internal swelling. Airflow improves progressively over the first weeks. Definitive shape takes six to twelve months, and up to eighteen months in thick skin or revision cases.
Coming from abroad or from another state
The practice is private, without insurance contracts. The clinic issues documentation for reimbursement requests, including the functional portion such as septoplasty, turbinoplasty and sinus surgery, and can provide documents in English or Spanish when requested.
Patients traveling from outside Brazil usually start with a teleconsultation, run preoperative tests at home, arrive one or two days before surgery and stay around seven days until the splint is removed. Flying is released after that. Follow up visits at one, three, six and twelve months can be in person or online. The full logistics are described on the international patients page.
When to see Dr. Sella
Consider a consultation if you have persistent nasal obstruction, snoring linked to nasal blockage, a crooked nose after trauma, or breathing that got worse after a previous rhinoplasty. The visit lasts about one hour and includes internal nasal examination, standardized photographs, digital simulation and an explanation of the technique being considered. Indication, risks and surgical plan are individual and defined only after that evaluation. You can see the full overview of rhinoplasty or get in touch with the team in Portuguese, English or Spanish.
Otolaryngologist and facial plastic surgeon · CRM-PR 33.018 · RQE 17.984. PhD from FMRP-USP, founder of the Sella Learning Center. Updated on 2026-10-15.
Frequently asked questions
Can breathing and appearance really be corrected in the same surgery?
Yes. Septum, nasal valves and turbinates are treated in the same operation in which the dorsum and tip are reshaped, since they share the same cartilage and bone framework. The need for each step is defined after clinical and endoscopic examination.
Will my health plan cover functional rhinoplasty in Brazil?
The practice is private and does not work with insurance contracts. The clinic provides detailed documentation of the functional portion, such as septoplasty and turbinoplasty, so the patient can request reimbursement directly from the health plan according to its own rules.
Does rhinoplasty make breathing worse?
It can when the nasal valves are narrowed or the lateral cartilages are over resected. Techniques such as dorsal preservation, spreader grafts and valve support are used specifically to protect the airway while the shape is changed.
Does surgery cure allergic rhinitis?
No. Turbinoplasty reduces the volume of swollen turbinates and improves airflow, but allergy remains a clinical condition that requires ongoing medical treatment after surgery.
How long should an international patient stay in Maringa?
Around seven days after surgery, until the external splint is removed, plus one or two days before the procedure. Flying is usually released after splint removal, and follow up can continue online.
Is an ENT surgeon different from a plastic surgeon for this operation?
An otorhinolaryngologist is trained in nasal airway anatomy, endoscopic examination and sinus disease, which allows the functional assessment and the aesthetic planning to happen in the same consultation. Dr. Sella also holds European Board certification in facial plastic and reconstructive surgery.
How do I know if my breathing problem comes from the septum, the turbinates or the nasal valve?
Only an internal examination can separate these causes, and often more than one is present at the same time. In the consultation the nose is examined internally, including endoscopy when indicated, and the valves are observed during deep inspiration to see if they collapse. Turbinate size and mucosal inflammation are also documented. The treatment plan follows what is found, not what the outside of the nose suggests.
Does correcting the airway change the final shape of my nose?
Yes, in many cases it does. Straightening a deviated septum can recenter a crooked tip and change how the dorsum looks from the front. That is why the functional and aesthetic steps are planned together, with standardized photographs and digital simulation, so you understand what each correction contributes to the final result.
Will I need nasal packing after functional rhinoplasty?
Most patients do not need packing. In selected cases a thin silicone internal splint is used for about ten days to stabilize the septum, and it is far more comfortable than traditional packing. Saline irrigation is started early to keep the nasal cavity clean, and you should never blow your nose during the first weeks.
How long does it take to breathe better after the surgery?
The inside of the nose stays swollen for several weeks, so breathing usually improves gradually rather than immediately. Many patients notice a clear difference after the first month, with continued improvement over the following months as internal edema resolves. The external shape takes longer, with the definitive result between six and twelve months, and up to eighteen months in thick skin or revision cases.
Book a consultation with Dr. Guilherme Sella
In person in Maringá, Brazil, or by video consultation. English-speaking team.