a plastic surgeon doing some pre operation to a female patient for scarless rhinoplasty

Scarless Functional Rhinoplasty Specialist

Deepak raj Dugar, md

Plastic Surgeon located in Beverly Hills, CA

A lot of surgeons are comfortable with using scarring procedures when it comes to performing Rhinoplasty, but Dr. Dugar goes above and beyond for his patients. At Beverly Hills Rhinoplasty Center™ located in Los Angeles, CA, Dr. Dugar offers closedor scarlessRhinoplasty for his patients.

Scarless Functional Rhinoplasty Q & A

Learn more about the 3 most common causes of difficulty breathing through your nose.

Dr. Deepak Dugar, a nose job specialist, doing a scarless rhinoplasty on a female patient

Can functional rhinoplasty address nose breathing issues caused by a deviated septum, turbinates, and nasal valves?

Scarless functional rhinoplasty can be performed solely to fix nose breathing issues or in combination with cosmetic Scarless Nose™ rhinoplasty. Whatever option you choose, fixing nose breathing issues is always done with a scarless approach at the Beverly Hills Rhinoplasty Center™ by Dr. Deepak Dugar. Addressing a deviated septum and other anatomical concerns through functional rhinoplasty is Dr. Dugar’s passion, as he trained as a Head and Neck, Ear, Nose, and Throat surgeon; as such, operating inside the nose has become second nature for him. Many plastic surgeons who don’t come from an Ear, Nose, and Throat background do not understand the intricacies of the internal nasal anatomy and can stumble when addressing breathing issues. This is where Dr. Dugar’s rigorous training sets him apart from the average plastic surgeon.

Breathing issues can arise from a variety of factors, including:

  • Septum – addressed with a septoplasty procedure
  • Turbinates – addressed with turbinate procedures
  • Nasal valve – addressed with nasal valve repair
  • Allergies – addressed with medications
  • Polyps, chronic sinusitis, or other medical conditions

What is a deviated nasal septum and how can septoplasty fix it?

The septum is the wall in the middle of the nose. Normally, it is straight and separates the nose into left and right cavities. The septum is composed of cartilage in the front and bone in the back, and extends from the tip of the nose to the back of the throat. A deviated nasal septum can be caused by many factors, the most common of which is trauma. Trauma to the nose can be sustained at an older age or even as a crawling toddler who falls on his/her face. Though the cartilage is weak and can be easily bent, there may be no bleeding or external injury at all. Deviated septum often go undiagnosed and only come to light at a much older age due to breathing issues. Sometimes, however, a deviated nasal septum can be so severe that it also causes cosmetic issues because it makes the nose look crooked or bent. When a deviated nasal septum is mild, there are usually no breathing issues so surgical intervention is not required. When the deviation is severe, however, nasal obstruction can occur, causing breathing difficulties from the nose, in which case nasal septum deviation septoplasty may be called for. During nasal septum deviation septoplasty, Dr. Dugar uses tiny incisions inside the nose (no external cuts or scars) to access the deviated portions of septal cartilage and bone. He then removes or straightens these deviated portions in order to rebuild a completely straight septum, which provides enhanced breathing for life. After the nasal septum deviation septoplasty, the removed pieces of cartilage will be used as grafts to strengthen the nasal valves as an added bonus.

close up shot of hands of a beverly hills rhinoplasty specialist in a surgery

What problems can enlarged inferior turbinates cause?

The turbinates are structures inside the nose and each person has three: inferior, middle, and superior. The inferior turbinates are long, finger-like structures that are bone on the inside, soft tissue in the middle, and mucosal lining on the outside—and they play a crucial role.

The turbinates warm, humidify, and moisten the air we breathe. This humidified air travels to the back of the throat and into the lungs. There, the oxygen from the inhaled air travels across tiny membranes into the blood, allowing oxygenated blood to travel to the heart, which pumps it to every cell in the body. The oxygen exchange process in the lungs is very delicate and requires a proper level of humidification for optimal results. Studies have shown that when patients have nasal obstruction from a deviated septum, they cannot get enough air to their turbinates; as a result, the body may not receive peak oxygenation. Paradoxically, enlarged inferior turbinates can also cause nasal obstruction. Enlarged inferior turbinates can be caused by allergies as well as anatomical anomalies. If the turbinates are too large and do not respond to allergy treatment (see below), we can perform a wide variety of turbinate surgery procedures to shrink their size while preserving their critical function. Turbinate surgery may include partial turbinectomy, submucosal resection, turbinate cautery, turbinate coblation, turbinate out fracture, or a combination of the above. As a leading expert in scarless nose procedures, Dr. Dugar assures patients that turbinate surgery will not leave unsightly external scars.

best nose surgeon in beverly hills with a plastic surgery nurse doing a bulbous nose job

How can spreader grafts rhinoplasty solve nasal valve collapse?

Inside the nose, on both sides, are internal and external nasal valves. These valves are small, narrow areas where nasal airflow is noticed the most. The external nasal valve is an area formed by the columella, the nasal floor, and the caudal margin of the lower lateral cartilage (or nasal rim). However, trauma or genetic variations can cause external nasal valve collapse which causes significant breathing difficulties for people. Dr. Dugar provides expert grafting and maneuvers to open up your external nasal valve collapse, leading to better breathing for the rest of your life.

The internal nasal valve, meanwhile, is a triangular area bound by the caudal border of the upper lateral cartilage, the septum, and the anterior head of the inferior turbinate. This internal nasal valve area is extremely narrow and is susceptible to further narrowing when a patient has a deviated septum, a collapse of the upper lateral cartilages, or enlarged inferior turbinates. During surgery, Dr. Dugar addresses narrow interior nasal valves to facilitate better and easier breathing. One of Dr. Dugar’s favorite maneuvers to increase the angle of the internal nasal valve and improve your breathing is by using spreader grafts rhinoplasty. This procedure involves using small pieces of cartilage (usually harvested from deviated portions of the nasal septum during a septoplasty) that are sculpted and shaped into perfectly sized grafts which are placed within the nose to help augment the angle of the internal valves. In this way, spreader grafts rhinoplasty can improve nasal breathing and help resolve nasal valve or mid-third collapse.

Can a rhinoplasty surgeon help with nasal allergies or nasal obstruction?

Allergies are a common cause of nasal obstruction—in fact, 1 in 5 Americans suffer from them. Unfortunately, nasal allergies cannot be solved surgically, though they can be treated with medications. Left unmanaged, allergies can cause severe nasal mucosa inflammation and inferior turbinate hypertrophy, both of which can cause nasal obstruction. If Dr. Dugar determines that you don’t have anatomical issues that lead to nasal obstruction, he will provide options for medical allergy management instead.