When most people hear the phrase nose job, their minds immediately jump to aesthetics. They picture a refined profile, a smaller tip, or a straighter bridge that looks perfect in selfies. We get it, Beverly Hills is the epicenter of beauty, and looking good matters. But here's the thing: a cute nose doesn't mean much if you can’t get a full breath of air through it.
For a massive portion of the patients walking into our office, rhinoplasty is about vitality. It’s about stopping the chronic mouth-breathing, fixing the restless sleep, and finally getting through a spin class without feeling like you are breathing through a coffee stirrer.
When nasal obstruction turns every basic life function into a conscious struggle, the conversation shifts from "Does this look good?" to "Does this work?" This is the domain of functional rhinoplasty. It is the side of nose surgery that focuses on the engine under the hood, ensuring your nasal airway works as beautifully as it looks.
Relying on nasal strips, sprays, and over-the-counter supplements just to get through the night gets old. Let’s break down why your nose is blocked, how we fix it, and why you don't have to sacrifice your looks to breathe like a champion.
The nose is supposed to be an effortless intake system. It is a complex radiator, humidifier, and filter designed to process the air you breathe before it hits your lungs. When this system fails, it affects everything from your energy levels to your focus.
Chronic breathing problems rarely fix themselves because they usually come down to structural roadblocks within the nasal passages. You can’t yoga-breathe your way out of a bone spur or a collapsed valve. Here are the three usual suspects that restrict nasal airflow:
The most frequent culprit is the nasal septum. Ideally, this wall of cartilage and bone runs straight down the middle, dividing your nose into two equal chambers. It’s the central pillar of the nose. However, a perfectly straight septum is actually like a unicorn: extremely rare.
Most of us have a slight deviation, but when the septum leans significantly to one side, a condition known as a deviated septum, it physically blocks the air on that side. This deviated nasal septum might be something you were born with (congenital) or the result of an old sports injury you forgot about. The result is the same: one nostril feels permanently "off," leading to chronic congestion, sinus infections, and often contributing to obstructive sleep apnea.
It’s often a double whammy. We frequently see a deviated septum paired with swollen inferior turbinates. These are long, sausage-like nasal tissues that line the sides of the nasal airway. Their job is to warm and humidify the air.
However, turbinates are reactive. If you have allergies or a long-standing deviation, they can become chronically enlarged (hypertrophy). When they get too big, they crowd the nasal airway even more. It’s like trying to walk down a hallway where the walls are closing in. A solid functional rhinoplasty plan often involves turbinate reduction along with fixing the septum to open everything up.
This is the one that often gets missed. The internal valve is the narrowest part of the nasal airway. It’s the "choke point" of the nose. If the side walls of your nose are weak or the angle is too narrow, your nostrils might pinch shut when you take a deep breath.
If you have ever pulled your cheek skin to the side to breathe better (the Cottle Maneuver), you likely have nasal valve collapse. This is a structural weakness that requires reinforcement, not just tissue removal.
Repairing a compromised airway requires sophisticated structural engineering. Unlike a standard cosmetic rhinoplasty that might focus on reduction (shaving down a bump or narrowing a tip), functional rhinoplasty often involves building. We are not just removing the roadblock; we are reinforcing the walls to prevent the nose from collapsing when you inhale.
To fix a collapsing internal valve or a crooked middle vault, an experienced surgeon utilizes spreader grafts. Think of these as tiny structural shims made of cartilage.
Where do we get this cartilage? Usually, we harvest it from the nasal septum itself during the correction of the septal deviation. We then place these strips between the septum and the side walls of the nose. This physically widens the bridge, just by millimeters, which significantly opens the airway angle.
Using a cartilage graft allows us to rebuild the nose with your body’s own natural tissue. This creates a sturdy, durable framework that supports respiratory function for a lifetime.
For the inferior turbinates, the aim is reduction, not total removal. We need them to function (otherwise you get a dry, crusty nose), but we need them to be smaller. We typically use radiofrequency or a small excision to shrink the tissue while preserving the mucous membrane. This creates immediate space for nasal airflow without compromising the nose's ability to filter air.
It’s important to distinguish between the two. A septoplasty strictly addresses the deviated septum inside the nose. It doesn't change the nose's shape. A functional rhinoplasty (or septorhinoplasty) addresses the septum and the structural support of the external nose, like the valves and the nasal bones. This is why seeing a specialist who is dual-trained as a facial plastic surgeon and an ENT is crucial; they understand both the form and function.
There is a persistent myth that you must choose between a nose that works and a nose that looks cute. That’s just not true. In fact, form and function are total besties.
A twisted nose that throws off your facial balance is often just the external sign of a severe internal deviation. You cannot have a straight house on a crooked foundation. Straightening the nasal bones and septum to help you breathe often naturally results in a straighter, more symmetrical external nose.
Another common overlap is the drooping nasal tip. If the tip of your nose plunges downward when you smile or as you age, it can cut off airflow. By using cosmetic rhinoplasty techniques to lift and support the tip, we not only give you a more youthful, refined profile but also open the external valves for breathing more easily.
At Eos Rejuvenation, we view facial plastic surgery through a holistic lens. Whether you are seeking reconstructive surgery after trauma or simply want to stop being a mouth-breather, we can simultaneously refine the aesthetic. We can smooth a dorsal hump, refine a bulbous tip, and create facial balance, all while we are under the hood fixing the engine.
By combining aesthetic surgery principles with functional repair, the final result enhances your facial harmony while solving your medical problems. You don't have to look "done" to breathe better, and you don't have to settle for a blocked nose to look good.
This is the big question everyone asks: "Does insurance cover functional rhinoplasty?"
The answer is: It depends on the "why."
Medical problems like a deviated septum, enlarged turbinates, or valve collapse caused by trauma are often covered by insurance because they cause breathing impairment and impact your health. Procedures like septoplasty and turbinate reduction are typically deemed medically necessary.
However, the cosmetic portion of the surgery, refining the tip, shaving down a bump, or narrowing the nostrils, is considered purely cosmetic and is generally an out-of-pocket expense.
When we perform a combination surgery, we split the bill. We submit the functional portion to your insurance and provide you with a quote for the cosmetic portion. This is often the most cost-effective way to get the nose you want, as you are already undergoing general anesthesia and paying for the facility fee for the medical portion. During your initial consultation, our team helps navigate these details so there are no surprises.
We know the idea of surgery on your face is intimidating. But the reality of recovery is often much milder than the anticipation.
Breathing easier begins immediately. You will be under general anesthesia, so you’ll sleep through the entire procedure. You’ll wake up in the recovery room feeling groggy but done.
The biggest surprise for most patients? It’s not as painful as they expect. Most describe the sensation as heavy head congestion, like the worst sinus cold of your life, rather than acute, sharp pain. Pain medications are available, but many of our patients switch to Extra Strength Tylenol within a few days.
Let’s bust a major myth: we do not stuff your nose with yards of gauze. That is old-school torture. Instead, we utilize soft splints. These are thin, flexible silicone sheets that sit inside the nose to keep the septum straight during the healing process. They often have a small tube built in to allow for some airflow even while you are swollen.
Sometimes, patients come to us after having a nose job elsewhere that made their breathing worse. This happens when a surgeon focuses solely on making the nose smaller (reduction) without reinforcing the structure. If you shrink the nose but don't support the valves, they collapse.
We specialize in revision rhinoplasty with a functional focus. This often involves additional surgery to graft cartilage back into the nose to reopen the airway. It is complex work, but for patients who have been struggling to breathe for years after a cosmetic procedure, it is life-changing. If you have suffered a septal perforation or collapse from previous work, know that there are reconstructive options available.
Living with a breathing impairment is exhausting. It messes with your sleep, your workouts, and even your sense of smell. If you are relying on over-the-counter supplements, strips, or sprays just to function, you are managing the symptom, not the problem.
If you suspect a deviated septum or struggle with chronic obstruction, a physical examination by a board-certified facial plastic surgeon is the necessary first step. You need someone who understands the complex relationship between the head and neck structures and overall proportions.
During your initial consultation, Dr. Nima Shemirani will use a specialized camera to look inside your nose. He will identify the most common causes of your obstruction—whether it’s the septum, the turbinates, or the valves—and create a tailored surgical plan. We will discuss your patient goals, both functional and aesthetic, to ensure we are on the exact same page.
We invite you to discover how functional rhinoplasty can restore not just your facial balance, but the simple, underrated joy of a deep, clear breath.
