Functional-aesthetic rhinoplasty.

A functional-aesthetic rhinoplasty, also known as a septorhinoplasty, is an operation that addresses both medical and aesthetic aspects of the nose. Functionally it is about improving nasal breathing, which may be impaired by anatomical disturbances. Aesthetically the external shape of the nose is adjusted — whether by reducing a hump, refining the nasal tip or adjusting the width of the nose.

At the Kuzbari Centre these procedures are carried out by experienced specialists — Univ.-Doz. Dr. Rafic Kuzbari, Dr. Christoph Grill and DDr. Jessica Wittmann. Thanks to our Vectra 3D simulation you can see before the operation how your new nose will look and function.

The name already says what it is about: septum stands for the nasal septum, rhinoplasty for the shaping of the external nose. Both in one word — and in one operation, because in the same nose both depend on the same material. Choosing a septorhinoplasty therefore does not mean choosing two operations at once, but one that treats the nose as a whole — from the inside as well as the outside.

Anyone who understands where the air is held up inside the nose also understands why shape and function are so closely connected. The airway has four critical points, and above each of them lies an area that determines the appearance of the nose.

The nasal septum stands vertically in the middle, separates the airways and at the same time supports the nose bridge and the nasal tip. It is the point at which shape and function are literally the same component.

The internal nasal valve, a gap a few millimetres wide between the nasal septum and the upper lateral cartilages, is the narrowest point of the entire airway. Above it lies the middle third of the nose — the part whose width, seen from the front, shapes the overall impression.

The turbinates on the side wall warm, moisten and clean the air. They are not visible from outside and, alone among the four points, have no direct effect on shape — they are the area where the work is purely functional.

The external nasal valve is the region of the nasal openings, held open by the outer limb of the alar cartilage. That very cartilage also gives the nasal tip its shape. Narrowing the tip means intervening in breathing — and supporting the valve alters the tip.

From this overlap follows the principle by which we operate: the airways are secured first, then the shape is built — and at the end we check whether the shaping work has left the airways unchanged.

Treating shape and breathing in a single procedure is not a question of convenience. It is a question of anatomy: the structures that hold a nose in shape are the same ones that hold the airway open. Four examples make this tangible.

The nasal septum supports the nose. It is the central support for the nose bridge and the nasal tip — and at the same time the dividing wall between the airways. If it is straightened in order to improve breathing, the support of the nasal tip inevitably changes. Without a countermeasure, drooping of the nasal tip can follow; after a purely functional operation the nose looks different from before.

A hump lies above the narrowest point. When the nose bridge is lowered, the very area in which the internal nasal valve lies is altered — the narrow gap between the nasal septum and the upper lateral cartilages, the narrowest point of the entire airway. A purely aesthetic hump correction can worsen breathing if this area is not secured.

The nasal tip holds the nasal opening open. The outer limb of the alar cartilage gives the tip its shape and at the same time prevents the nasal opening from collapsing as you breathe in. Removing substance at the tip in order to narrow it means intervening in breathing.

A crooked nose is almost always both. The crookedness visible from outside is usually caused by a deviated nasal septum that narrows one side at the same time. Here shape and breathing have the same cause — and the same solution.

That is why we plan every rhinoplasty from both sides, even if you come to us for only one of the two concerns. A nose that looks better after the operation and functions worse would not be a good result for us — and just as little the other way round.

Nose-bridge-preserving, where the findings allow it. We work extensively with the modern nose-bridge-preserving technique, known as dorsal preservation, and with hybrid techniques — not exclusively with the traditional structural septorhinoplasty. The natural nose bridge is preserved rather than being removed and rebuilt. The result looks particularly natural, it is stable in the long term, and the risk of later irregularities on the nose bridge is reduced — which counts above all with thin skin. Certain forms of crookedness also recur less often. For the functional-aesthetic correction the technique has an additional advantage: where the roof above the nasal septum is not opened, the internal nasal valve also retains the width it grew with.

Cartilage-supported at the nasal tip. We stabilise the nasal tip with modern cartilage-supported techniques. This considerably reduces the risk of drooping of the nasal tip over the years. With a combined operation this is doubly important, because straightening the nasal septum takes away support from the tip that has to be replaced.

Septoplasty with the supporting structure preserved. The nasal septum is released from its tension and realigned; a supporting marginal strip always remains in place. The cartilage obtained in the process is at the same time the material for all stabilisation work — a further reason why both goals can be achieved better in one procedure than separately.

Spreader grafts. Narrow strips of cartilage between the nasal septum and the upper lateral cartilages hold the internal nasal valve open and at the same time shape the line of the middle third of the nose. One measure, two effects — that is the essence of this operation.

Function-preserving treatment of the turbinates. Reducing rather than removing: the turbinates should continue to warm, moisten and clean the air you breathe.

Piezotome for the bone work. An ultrasound instrument that cuts and smooths bone while leaving soft tissue, mucous membrane and blood vessels untouched. This means more precise bone work and, as a rule, less bruising and swelling. It is not a method in its own right — it is a tool for one step, which we use as standard in every nose surgery.

A rhinoplasty with us takes one to four hours. That range is deliberate: we operate in our own operating theatres and therefore without time pressure — for as long as it takes until every detail is right. How long an operation takes is decided by the findings, not by the schedule.

A functional and aesthetic correction tends towards the upper end of that range, and for an understandable reason: there are two goals, and they influence one another. After every step on the shape we check again whether the airways have remained just as wide; after every functional step we check what it has done to the shape. These loops of checking are the actual work.

For you, the combination still has a clear advantage: one anaesthetic, one operation, one healing phase — instead of going the same way twice. You will spend the rest of your life with your new nose; if the operation takes half an hour longer in order to improve the result, that is a very short time in relation.

A great deal is said about the shape of a nose, and rarely about its function. Yet it is usually breathing that patients report on first once healing is complete — because the difference shows not in the mirror, but in the course of the day.

Sleep. Anyone who does not breathe through the nose at night switches to mouth breathing: restless sleep, a dry throat in the morning, frequent waking. Many do not consider themselves poor sleepers at all — they simply know nothing else.

Exercise. Here the effect is immediate. If nasal breathing is not sufficient, you switch to mouth breathing sooner and tire more quickly. After about four to six weeks light endurance exercise is possible again — for many the moment at which the difference is most noticeable.

The nose itself. Mouth breathing bypasses the air-conditioning system of the nose; the air arrives in the throat cold, dry and unfiltered. Sore throats and lingering colds become more frequent. When nasal breathing returns, this often settles.

And the shape. The second part of the result shows itself more slowly, but lastingly: a nose that is no longer the first thing you notice in the face. Many patients describe how they stop automatically turning their head in a particular direction when being photographed.

Age. Because the external shape is also changed, we operate once facial growth is complete — as a rule from about the age of 16 in women, and somewhat later in men. If a marked obstruction of breathing is the main concern, we discuss the timing on an individual basis. There is no upper age limit.

Clarified beforehand. A known allergy, a suspected disorder of the paranasal sinuses or a dependence on decongestant nasal sprays should be clarified before the operation. Otherwise expectations arise that a surgical procedure cannot meet — and that is precisely what we want to avoid.

Two weeks before. Avoid blood-thinning preparations, unless they are medically prescribed, and avoid nicotine: smoking measurably impairs the healing of the mucous membrane. Everything else about the preparation you will receive in writing.

Afterwards. Allow a week until the splints are removed, two to three weeks until you are presentable in public, and expect the shape to become final only after months. Breathing is stable considerably earlier — usually just a few weeks after the procedure.

What is readily achievable: a nose that looks coherent in the face and through which you breathe freely. One healing phase instead of two. And a result that still holds after years, because the supporting structures were deliberately stabilised.

There are limits, too. An allergy and disorders of the paranasal sinuses are not treated by the operation — they should be clarified before expectations arise. Nasal breathing also remains subject to fluctuation: weather, colds and the normal alternation of the turbinates between the two sides are part of a healthy nose. And the thickness of the skin continues to determine how much definition can be achieved at the tip, and when.

A conflict of aims that we raise. Some wishes about shape and some functional requirements pull in different directions — a very narrow nose, for instance, where the airways are already tight. In such cases we tell you where the limit lies and propose the option that supports both. The result may then be more restrained than you had expected, but it is one you will still be happy with in ten years' time.

An initial consultation with three-dimensional simulation, a technique that suits your nose, and an operating time that follows the findings — this effort is the reason why rhinoplasty with us has its price. It is also the reason why the result is meant to hold: for a lifetime, not for a few years.