Septorhinoplasty: Planning Breathing Function and Nasal Shape Together

About my current practice: I, Dr. Walter Zamarian Jr., no longer perform rhinoplasty, either on its own or combined with other procedures, including septorhinoplasty. This article remains available as educational content only and is not an offer to evaluate or schedule rhinoplasty or septorhinoplasty.

Not every breathing problem comes from a deviated septum alone. The nasal valve, the turbinates, rhinitis, sinusitis, allergies, collapsing cartilage, previous injury, and earlier surgery can all play a part. That is why septorhinoplasty has to start with a diagnosis, not with a cosmetic wish considered in isolation.

I am Dr. Walter Zamarian Jr., a plastic surgeon in Londrina, Brazil (medical license CRM-PR 17.388; plastic surgery specialty registration RQE 15.688), and a member of the Brazilian Society of Plastic Surgery (SBCP) and the American Society of Plastic Surgeons (ASPS). I have performed more than 8,000 operations over two decades in practice; today, by deliberate choice, I perform three facelifts a week, about 150 a year. During the years I performed rhinoplasty, I took facial harmony, structural support, and nasal function into account together.

What is septorhinoplasty?

Septorhinoplasty brings two goals together. Rhinoplasty addresses the shape and proportions of the nose: the bridge (nasal dorsum), the tip, width, projection, and how the nose harmonizes with the rest of the face. Septoplasty addresses problems with the septum, the wall of cartilage and bone that divides the two nasal passages.

When a deviated septum affects both nasal breathing and the support of the nose, treating appearance and function within the same plan can make technical sense. Septal cartilage can also serve as a source of structural grafts, especially to support the nasal tip, the bridge, or the nasal valve.

Does a deviated septum always need surgery?

No. Many people have some degree of septal deviation without meaningful symptoms. Surgery is usually considered when there is significant nasal obstruction, mouth breathing, worse sleep, difficulty during physical activity, recurrent sinusitis, or when the septum interferes with the structural planning of a rhinoplasty.

Even then, the indication has to be individual. Allergic rhinitis, enlarged turbinates, and chronic inflammation can cause similar symptoms. If those factors are not recognized, surgery may correct the septum and still leave breathing complaints behind.

The nasal valve and the turbinates

The nasal valve is one of the narrowest parts of the airway. Small changes in angle or support, or a collapse of the valve, can cause significant obstruction. In some patients, septorhinoplasty has to include maneuvers that support the nasal valve, using specific grafts or sutures.

The turbinates are internal structures that help warm, filter, and humidify the air we breathe. When they are enlarged by rhinitis, allergy, or chronic inflammation, they can narrow the airway. Any decision to treat the turbinates has to be made carefully, because removing or reducing them too much can also cause symptoms.

Why appearance and function have to be planned together

The nose is a three-dimensional structure. The bridge, the septum, the tip, the upper lateral cartilages, the nasal bones, and the nasal valve are all connected. Changing only the cosmetic side without respecting support can worsen function; correcting only function without considering shape can leave visible deformities or instability.

This is why structural rhinoplasty techniques can be important. Septal cartilage grafts, when available and well indicated, help support the tip, the bridge, the valve, and areas of asymmetry. The aim is not simply to make the nose “thinner” or “lift” it, but to preserve a working airway.

Septorhinoplasty and ultrasonic rhinoplasty

When the nasal bones need to be worked on, piezoelectric technology can be a useful tool in selected cases. The overview of ultrasonic rhinoplasty explains the difference between an instrument and a plan: technology helps, but it does not replace diagnosis and technique.

In septorhinoplasty, the central point remains integrated planning. The choice of instruments depends on the anatomy, the type of deformity, skin thickness, the bony framework, and the functional need.

Recovery and aftercare

Recovery after rhinoplasty and septorhinoplasty may involve a nasal splint, tape, nasal rinses, swelling, bruising, temporary obstruction, internal crusting, and regular follow-up visits. Nasal breathing can fluctuate during the first weeks because of swelling and secretions.

That is why assessing function too early can be misleading. Some early obstruction is expected. A more reliable reading of breathing and nasal shape requires follow-up, proper cleaning, control of rhinitis when present, and time for the tissues to mature.

Risks and limits

Like any surgery, septorhinoplasty involves risks. They include bleeding, hematoma, infection, persistent obstruction, asymmetry, irregularities, changes in sensation, the need for revision, septal perforation (an abnormal opening in the wall that separates the nasal passages), and dissatisfaction with shape or function.

The article on realistic expectations and real risks in plastic surgery explains why risk should never be hidden. In septorhinoplasty, safety depends on diagnosis, technique, structural support, anesthesia, postoperative care, and follow-up visits.

What if I have already had nose surgery?

Revision cases call for particular care. There may be internal scarring, too little septal cartilage left, changes to the nasal valve, stiffer skin, and greater unpredictability. The overview of revision (secondary) rhinoplasty explains why revisions are more complex.

In these cases, functional evaluation matters even more. Sometimes it is necessary to consider cartilage from other parts of the body, examine the nasal valve in greater detail, and align expectations about what can realistically be improved.

How to choose a surgeon

For septorhinoplasty, look for a professional who can explain both shape and function. Ask about the septum, the nasal valve, the turbinates, grafts, limitations, risks, recovery, and the possibility that symptoms may persist. The article on how to choose a rhinoplasty surgeon sets out objective criteria.

An otolaryngologist (ear, nose, and throat specialist) may also take part in specific cases, especially when there is significant rhinitis, chronic sinusitis, sleep apnea, nasal polyps, or a need for broader functional investigation. The best plan is the one that addresses the patient’s real problem.

Medical sources and further reading

For further reading, I recommend the guidance from the American Academy of Otolaryngology on deviated septum, the information from the American Society of Plastic Surgeons on rhinoplasty, and the AAO-HNS position statement on the diagnosis and treatment of the nasal valve, revised in July 2026.

Septorhinoplasty can bring appearance and function together when the indication is right. Above all, the decision should not be reduced to looks: breathing well, keeping the nose supported, and respecting anatomical limits are all part of the same treatment.

Dr. Walter Zamarian Jr.

Plastic surgeon in Londrina, Brazil (CRM-PR 17.388 | RQE 15.688), full member of SBCP and ASPS. He has worked in plastic surgery for more than 20 years, with a focus on individualized planning, patient safety, Deep Plane facelift, eyelid surgery, facial fat grafting, and female intimate surgery.