Rhinoplasty and Breathing: Form and Function Are One Operation

Why breathing and appearance belong in the same plan

The structures that shape the outside of the nose also govern airflow on the inside. Cartilage that tilts a profile to one side can simultaneously narrow an internal passage. Bone that creates a visible hump may also contribute to obstruction. Treating one without evaluating the other leaves half the picture unexamined.

At Tulsa Surgical Arts, rhinoplasty is performed by Dr. Angelo Cuzalina — an experienced rhinoplasty author and past president of the American Academy of Cosmetic Surgery — and Dr. Chase Nelson, a cosmetic otorhinolaryngologist (ENT) who completed fellowship training at this practice. Both surgeons evaluate the airway and the external shape together during every consultation.

This dual perspective matters. A purely cosmetic narrowing that ignores internal anatomy can worsen breathing. A purely functional repair that ignores external shape can leave a visible irregularity. The goal is a nose that works well and looks natural — balanced to fit your face, not a template.

Common functional issues addressed during rhinoplasty

A deviated septum is the most familiar source of nasal obstruction. The septum is the thin wall of cartilage and bone that divides the nose into left and right passages. When it bows to one side, airflow through that passage is reduced. During rhinoplasty, the septum can be straightened and repositioned. Cartilage removed during this correction is often repurposed as graft material for structural support elsewhere in the nose.

Turbinate hypertrophy is another frequent finding. The turbinates are small, shelf-like structures along the inner walls of the nasal cavity. They warm and humidify air. When they enlarge — from chronic inflammation, allergies, or other causes — they crowd the airway. Reduction of the turbinates can be performed at the same time as the cosmetic reshaping, adding little to the overall operative time.

Both of these functional issues — deviated septum and turbinate hypertrophy — are remedied as part of the rhinoplasty operation at our practice when they are present [source: procedure page facts]. The surgeon identifies them during your examination and discusses them before any plan is finalized.

What happens in the operating room

General anesthesia is administered by a board-certified anesthesia provider in our AAAHC-accredited surgery center. You are fully asleep. A small incision is made in the columella — the strip of skin between the nostrils — and just inside the nostrils. The skin is lifted off the underlying cartilage and bone so the surgeon can see and address every layer.

Bone and cartilage are refined through judicious removal and repositioning with sutures. Grafts are often placed for support and contour. If a deviated septum or enlarged turbinates are present, they are corrected during this same window of access. The nasal skin is then laid back into place, incisions are closed with fine suture, and internal splints are placed followed by external tape and a protective splint. Surgery typically takes one and a half to three hours. Most patients return home the same day with a responsible adult.

Every step is discussed with you at consultation, and your written surgical plan is set before surgery is ever scheduled.

The textbook record behind our approach

Our rhinoplasty philosophy is informed by years of published work. Dr. Cuzalina co-wrote "Revision Rhinoplasty" in 2012 [3], contributed to a rhinoplasty issue preface that same year [4], authored "Rhinoplasty for the Cleft Lip and Palate Patient" in 2016 [2], published "Challenging Rhinoplasty for the Cleft Lip and Palate Patient" in 2021 [1], and co-authored work on the cleft nasal deformity in 2022 [0]. These chapters address noses where form and function are deeply intertwined — cleft and revision cases that demand structural precision.

That experience shapes how we approach every rhinoplasty, whether the concern is a subtle dorsal irregularity, a breathing complaint, or both. Complex cases teach a surgeon where the limits are. Those lessons carry forward into every operation.

We encourage you to consult a qualified surgeon who can examine your nose, assess your airway, and explain what a single well-planned operation can accomplish. If you are in Tulsa, about five miles from our practice in Broken Arrow, or traveling from farther away, our consultation is private and carries no obligation. Call 918-392-7900, text us, or book online.

Individual results vary. This article is general education, not medical advice.