Scarless Functional Rhinoplasty is something performed alone for purely functional (breathing) issues or in combination with cosmetic Scarless Nose™ Rhinoplasty to enhance the breathing in addition to enhancing the cosmetics of the nose. Either way, fixing the breathing is always done from a Scarless approach at the Beverly Hills Rhinoplasty Center™ by Dr. Dugar. Addressing the septum and the other anatomical areas of concern is a passion for Dr. Dugar, who is classically trained as a Head and Neck, Ear Nose, and Throat surgeon, where operating inside the nose became second nature for Dr. Dugar. Often, Plastic Surgeons who don’t come from Ear, Nose, and Throat backgrounds do not understand the intricacies of the internal nasal anatomy and can stumble when addressing the breathing. This is where Dr. Dugar surpasses the average plastic surgeon.
Breathing issues from the nose can come from multiple areas:
The septum is the wall in the middle of the nose. Normally, it is straight and separates the nose into left and right cavities. When you “pick your nose,” the wall in the middle is the septum. The septum is composed of cartilage in the front and bone in the back. It extends from the tip of the nose to the back of the throat. The septum can become deviated (Deviated Nasal Septum) from many factors, the most common of which is trauma. Trauma to the nose can be sustained at an older age or even as young as a crawling toddler who falls on his/her face and sustains a septal fracture. Because the cartilage is weak and can be easily bent at this age, there may be no bleeding or external injury at all. Often, these are undiagnosed and come to light at a much older age due to breathing issues. Sometimes, a deviated septum can be so severe it also causes cosmetic issues because it causes the nose to look crooked or bent from the outside as well. When a deviated septum is mild, there can be no breathing issues and this usually doesn’t require any surgical intervention. When the deviation is severe, however, nasal obstruction can occur, causing breathing difficulties from the nose, in which case surgical intervention may be warranted to straighten the septum. In order to repair a deviated septum, 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 for 100% patient nasal cavities for enhanced breathing for life. Often, the removed pieces of cartilage, instead of being thrown away, will be used as grafts to strengthen the nasal valves as an added bonus (see below).
The turbinates are structures inside the nose on each side. You have 3 on each side (inferior, middle, and superior turbinates). The inferior turbinates are the largest and have the most function in the nose. The inferior turbinates are long finger-like structures that are bone on the inside, soft tissue in the middle, and mucosa lining on the outside. The turbinates function to warm, humidify and moisten the air we breathe. This air that is now humidified can travel to the back of the throat and into the lungs. In the lungs, oxygen from the air travels across tiny membranes into the blood, to provide oxygenated blood to return to the heart and be pumped to every cell in the body. The oxygen exchange process in the lungs is very delicate and requires a proper level of humidification to process at the highest levels. Studies have shown that when patients have nasal obstruction from a deviated septum, they are not getting enough air to the turbinates, so there is inadequate humidification of the air being inhaled into the lungs. Remember, air inhaled from the mouth has no humidification system and therefore, becomes dry air in the lungs. Dry air in the lungs does not transfer oxygen into the blood as well as humidified air can so the oxygen levels in the blood can be less than normal. This is why proper nasal breathing is critical to obtain peak oxygenation levels in the body. But paradoxically, turbinates can also become too large as well and cause a paradoxical nasal obstruction. This can occur from allergies as well as anatomical variations. If the turbinates are too large and do not respond to allergy treatment (see below), we can perform a wide variety of turbinate surgical procedures to shrink their size while preserving their critical function, to allow a large nasal cavity for airflow. These include partial turbinectomy vs submucosal resection vs turbinate cautery vs turbinate coblation vs turbinate out fracture or a combination of the above.
Inside the nose on both sides are Internal and External Nasal Valves. The nasal 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). Due to trauma or genetic variations, a collapse of the external valve can cause significant breathing difficulties for patients. Dr. Dugar helps these patients with expert graftings and maneuvers to help open up the external nasal valve for better breathing for the rest of your life.
The internal nasal valve 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 susceptible to further narrowing when a patient has a deviated septum, a collapse of the upper lateral cartilages, or enlarged inferior turbinates. During the nasal surgery, Dr. Dugar always addresses the nasal valves to assure better breathing for the rest of your life. 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.” Spreader grafts are 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 to be placed within the nose to help augment the angle of the internal valves. These can improve nasal breathing and help resolve nasal valve collapse (or mid third collapse) for the rest of your life.
Allergies are a common cause of nasal obstruction. 1 in 5 Americans (almost 60 million Americans) has allergies. Unfortunately, allergies cannot be surgically removed. They must be medically treated to optimize the nasal airflow. Consequences of unmanaged allergies can be severe nasal mucosa inflammation and inferior turbinate hypertrophy, both of which can cause nasal obstruction. If Dr. Dugar, after examining the inside of your nose during your Beverlconsult, determines you don’t have anatomical issues that can be addressed surgically, he will guide you through options for medical allergy management if that is the issue.
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