Functional rhinoplasty.

Functional rhinoplasty, also called septorhinoplasty or rhinoplasty with a functional focus, aims primarily at restoring unrestricted nasal breathing. It corrects anatomical problems in the nose that obstruct the airflow.

At the Kuzbari Centre these procedures are carried out by experienced specialists such as Univ. Doz. Dr Rafic Kuzbari, Dr Christoph Grill and DDr. Jessica Wittmann. Thanks to our Vectra 3D simulation you can visualise in advance how the correction will improve your breathing and, optionally, refine the external shape of the nose as well. This operation is medically indicated and is carried out as an inpatient procedure with an overnight stay.

The nose is not an open tube. It is a system of narrow points that slows the air, makes it swirl, warms, moistens and cleans it — which is precisely why nasal breathing feels different from mouth breathing. Breathing is almost always obstructed at one of four places, and each of them calls for a different treatment.

The internal nasal valve. A narrow cleft between the nasal septum and the lower edge of the upper lateral cartilages, a few millimetres wide — the narrowest point of the entire airway, and not visible from the outside. Even a slight narrowing has a large effect here, because the resistance rises disproportionately as the width decreases.

The nasal septum. It stands vertically in the middle and separates the airways. If it is bent, it narrows one side — often so gradually since childhood that those affected take it for normal.

The turbinates. Three paired, shell-shaped projections on the side wall, covered with mucous membrane that has a rich blood supply. They are not an obstacle but the climate organ of the nose: they warm and moisten the air. If they swell permanently, they narrow the passage.

The external nasal valve. The region of the nostrils, held open by the lateral crus of the alar cartilage. If these cartilages are weak or bent inwards, the side wall of the nostril is drawn inwards on forceful inhalation.

One detail that surprises many: the turbinates swell and subside in alternation — every few hours one side takes on more work than the other. This normal alternation goes unnoticed as long as both sides are clear. If one side is permanently narrow, it is noticed immediately: at night the clear side changes with the sleeping position, and during the day there are phases in which you get almost no air at all. Anyone who recognises this usually has more than just a blocked nose.

A blocked nose is regarded as a trifle. Anyone who has lived with one for years experiences it differently — and usually not as a problem of the nose, but as a series of complaints that at first sight have nothing to do with one another.

Sleep. Anyone who does not breathe through the nose at night switches to mouth breathing. Sleep becomes more restless, you wake more often, the throat is dry in the morning and the lips are chapped. Many of those affected do not consider themselves poor sleepers — they simply know nothing else.

Performance. Being short of sleep costs concentration. During exercise the effect is immediate: the nose becomes the bottleneck, you switch to mouth breathing sooner and tire more quickly.

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. And the permanently irritated mucous membrane swells further, which compounds the situation.

Reaching for the nasal spray. Decongestant sprays work immediately and reliably — and that is precisely where their danger lies. With continuous use, the mucous membrane swells more strongly than before each time the effect wears off. What began as a help becomes a dependence that masks the actual condition.

What matters to us about this: these complaints are not a price that has to be paid. Where an anatomical narrow point is the underlying cause, it can be corrected — and most patients, once healed, describe not so much a freer nose as better sleep.

Septoplasty — straightening the nasal septum. The bent portions are released from their tension, realigned and, where necessary, held in the middle with fine sutures or strips of cartilage. A supporting marginal strut always remains in place: the nasal septum is the support of the nose and must not be weakened. The cartilage obtained in the process is at the same time the material for the stabilisations elsewhere.

Turbinoplasty — reducing the turbinates. Gently and preserving their function. The turbinates should go on warming, moistening and cleaning — they are reduced, not removed. Too radical an approach at this point leads to a dry, uncomfortable nose that paradoxically feels blocked even though it is wide open. That is why we deliberately remain restrained here.

Spreader grafts — opening the internal nasal valve. Narrow strips of cartilage that are placed between the nasal septum and the upper lateral cartilages. They hold the narrowest point of the airway open and at the same time stabilise the line of the middle third of the nose. They are often of different thickness, because they have to compensate for an asymmetry.

Reinforcing the alar cartilages — stabilising the external nasal valve. Thin strips of cartilage give firmness to weak or inward-bent alar cartilages, so that the nostril stays open on forceful inhalation. For many patients this is the measure with the most noticeable effect during exercise.

Cartilage-supported stabilisation of the nasal tip. Even where the concern is purely functional, the same applies: if work is done on the nasal septum, that affects the support of the tip. We stabilise it with modern cartilage-supported techniques — which markedly reduces the risk of the tip dropping over the years. A functional operation should not make the shape worse along the way.

Where work is done on the bony base, the piezotome is used — an ultrasound instrument that cuts and smooths bone while leaving soft tissue, mucous membrane and vessels untouched. That means more precise work on the bone and, as a rule, less bruising and swelling. The piezotome is not a method in its own right; it is a tool for one part of the procedure. We use it as standard in every nose operation.

The Kuzbari Centre has its own state-of-the-art operating theatres. They are not only perfectly equipped for rhinoplasty — they also give us the luxury of completely free scheduling. Our well-established team of doctors, anaesthetists and assistants carries out nose and facial surgery exclusively, and thus creates the best conditions for your nose operation.

You cannot hide a nose — which is precisely why you should choose a team specialised in nasal surgery in a private clinic, as at the Kuzbari Centre. Here surgeons specialised in the nose operate in their own operating theatres, without time pressure and with full concentration on your result.

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.

In a functional procedure it is the nasal septum that determines the time. Straightening it means working with a material that is under tension and strives to return to its old shape. That happens in many small steps: releasing, aligning, checking, stabilising, checking again. Added to this are the measures at the nasal valves, which can differ between the two sides because the two sides are narrowed to different degrees.

That we are able to run through these loops is due to the operating theatres being our own. And it is worth it: breathing that is only “somewhat better” after healing would not be a good result for us.

Age. Where breathing is markedly obstructed, a correction can make sense earlier than it would for a purely aesthetic concern — we discuss that on an individual basis. For procedures that also affect the external shape, the rule still applies: after facial growth is complete, as a rule from about the age of 16 in women and somewhat later in men. There is no upper age limit.

Before the operation. In the two weeks beforehand, avoid blood-thinning preparations, unless they are medically prescribed, and avoid nicotine — smoking measurably impairs the healing of the mucous membrane. If there is a dependence on decongestant nasal sprays, we break that cycle beforehand; otherwise the operation would be addressing the wrong place.

Afterwards. Allow a week until the splints are removed, and expect the nose to be more blocked during that time than it was before. Light endurance exercise is possible again after about four to six weeks — often the moment at which the difference is most noticeable.

After a functional procedure, nasal care is not an accessory but a part of the treatment. The mucous membrane has to regenerate, and in doing so it forms crusts that further block a passage that is swollen in any case. Those who care for the nose consistently breathe freely sooner.

Rinsing. Saline rinses keep the mucous membrane moist and loosen crusts without tearing them off. How often and from when, we tell you on discharge — and we show you, so that it does not founder on the handling.

Moisturising. Nourishing ointments and sprays without decongestant active ingredients support healing. Decongestant sprays, by contrast, you use only if we expressly prescribe them.

Do not blow your nose. In the first few weeks the nose is not blown forcefully but dabbed carefully. When sneezing, it helps to open your mouth so that the pressure does not go into the nose.

Patience with crusts. Crusts come away by themselves if the mucous membrane is kept moist. Helping them along risks bleeding and delays healing.

You receive all of this in writing — along with the mobile number of your surgeon, in case anything is unclear.

What is readily achievable: considerably freer nasal breathing, where an anatomical narrow point is the cause. Less mouth breathing at night, better sleep, more air during exercise. And in many cases less snoring — although snoring has many causes and does not arise in the nose alone.

There are limits, too. An allergy is not treated by the operation. Nor are disorders of the paranasal sinuses. 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 do not disappear. And with obstructive sleep apnoea the nose is usually only one element — the assessment belongs in a sleep laboratory.

What we advise against: a radical reduction of the turbinates. It creates a great deal of space in the short term and leads in the long term to a dry nose that paradoxically feels blocked. And an operation before a dependence on decongestant nasal sprays has been broken.

And one point that matters to us: if after the examination we come to the conclusion that an operation will not help you, we say so — and we do not recommend one.

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.