Septorhinoplasty in Brazil: when breathing well and having a beautiful nose go hand in hand
If you have reached this page, you probably deal with two problems at the same time: difficulty breathing and dissatisfaction with the appearance of your nose. Perhaps you have had a diagnosed septal deviation for years and have always wanted to take advantage of the deviated septum surgery to also improve aesthetics. Or maybe your main complaint is aesthetic, but during the evaluation, you discovered that part of the discomfort you feel is related to a nasal obstruction that has never been investigated.
Whatever your case may be, septorhinoplasty -- also called rhinoseptoplasty -- is the surgery that resolves both problems in a single procedure. And this is exactly the approach I advocate in my practice as a plastic surgeon in Brazil: treating the nose as a functional and aesthetic unit because form and function are closely linked.
Over more than twenty years as a rhinoplasty specialist in Brazil and with over eight thousand surgeries performed, I have learned that the ideal nose is not just beautiful. It is a nose that functions perfectly, allowing for free and silent breathing, and looks naturally balanced with the rest of the face. Septorhinoplasty in Brazil is the tool that allows me to deliver this complete result. International patients seeking medical tourism for rhinoplasty in Brazil can combine both functional and aesthetic nasal correction in a single procedure.
What differentiates rhinoseptoplasty from simple rhinoplasty
In purely aesthetic rhinoplasty, the focus is on the external appearance of the nose: reducing the dorsal hump, refining the tip, narrowing the nostrils. In rhinoseptoplasty, we go beyond. In addition to all the aesthetic modifications, I correct the deviation of the nasal septum, treat the hypertrophy of turbinates, and resolve any obstruction that is compromising your breathing.
The advantage is clear: you undergo a single surgery, a single anesthesia, a single recovery, and resolve everything at once. It makes no sense to operate on the nose to improve appearance and leave a septal deviation untreated, knowing that it will continue to cause nasal obstruction, snoring, recurrent sinusitis, and poor sleep quality.
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Subscribe on YouTubeWhat is a deviated septum and why does it need to be corrected
The nasal septum is the wall of cartilage and bone that divides the nose into two cavities. Ideally, it should be straight, allowing balanced airflow through both sides. In practice, most people have some degree of deviation. The problem arises when this deviation is significant enough to obstruct airflow, causing a series of symptoms that directly affect quality of life.
Symptoms of a deviated septum
- Chronic nasal obstruction: constant feeling of a stuffy nose, usually more intense on one side.
- Oral breathing: when the nose doesn't function, you breathe through your mouth, which dries out the throat, disrupts sleep, and promotes infections.
- Snoring and apnea: nasal obstruction is one of the most common causes of snoring and can contribute to obstructive sleep apnea syndrome.
- Recurrent sinusitis: the deviation of the septum can block the drainage of the paranasal sinuses, favoring recurrent infections.
- Nasal headache: pressure from the deviated septum against the side wall of the nose can cause persistent headaches.
- Frequent nosebleeds: turbulent airflow over the deviated septum dries out the mucosa and causes epistaxis.
- Fatigue and difficulty concentrating: inadequate breathing during sleep compromises oxygenation and affects performance during the day.
Many patients live with these symptoms for years, adapting to them without realizing how much their quality of life is compromised. Only after surgery, when they breathe fully for the first time, do they understand the extent of the problem they had.
Turbinates hypertrophy: another villain of breathing
The nasal turbinates are bony structures covered by mucosa that are located on the lateral wall of each nasal cavity. Their function is to warm, humidify, and filter the air we breathe. When the mucosa of the turbinates excessively enlarges — known as turbinate hypertrophy — they begin to obstruct airflow, worsening nasal obstruction.
In rhinoseptoplasty, I simultaneously treat the deviated septum and turbinate hypertrophy, ensuring that both causes of obstruction are resolved. Partial turbinectomy or submucosal cauterization of the inferior turbinates are part of my approach when recommended.
Structured rhinoseptoplasty: my surgical philosophy
I use the structured rhinoplasty technique in all my nasal procedures, whether in purely aesthetic rhinoplasty or in rhinoseptoplasty. This philosophy, developed and refined over the last few decades, represents a fundamental shift from traditional reductive techniques.
What "structured" means
In the old rhinoplasty techniques, the surgeon basically removed cartilage and bone to reduce the nose. The immediate result could be beautiful, but over the years the weakened structure yielded to the force of healing, producing pinched noses, drooping tips, asymmetries, and often iatrogenic respiratory obstruction — that is, caused by the surgery itself.
In structured rhinoseptoplasty, I do the opposite: I reinforce the structure of the nose using cartilage grafts from the septum (and eventually from the ear or rib) to create a solid and stable architecture. First, I build the support, then I shape the form. It's like building a house: first the foundation and structure, then the facade.
Grafts I frequently use
- Columellar graft (strut): central pillar that supports and projects the nasal tip.
- Septal extension graft (spreader graft): widens the internal nasal valve, dramatically improving breathing.
- Shield graft (shield graft): defines and refines the nasal tip.
- Contour grafts (cap graft): smooth out irregularities and create natural transitions.
- Alar graft (alar batten graft): strengthens the lateral walls of the nose, preventing collapse during inspiration.
This approach produces more predictable results, more stable in the long term, and respects both aesthetics and respiratory function.
Open versus closed approach
In the vast majority of rhinoseptoplasties, I use the open approach (open rhinoplasty), which involves a small incision in the columella — that strip of skin between the nostrils. This incision gives me direct visualization of the entire nasal structure, allowing for precise and controlled modifications. The resulting scar is practically imperceptible after a few weeks.
In selected cases, I may opt for the closed approach, with exclusively internal incisions. The choice depends on the complexity of the case and the necessary modifications.
When rhinoseptoplasty is recommended
Rhinoseptoplasty is ideal for patients who present simultaneous functional and aesthetic complaints. In my experience in Brazil, this is the most common situation: the vast majority of patients who seek me for nasal surgery have some degree of functional impairment, even when the main complaint is aesthetic.
Functional indications
- Deviated nasal septum causing respiratory obstruction
- Inferior turbinate hypertrophy refractory to clinical treatment
- Collapse of internal or external nasal valve
- Recurrent sinusitis related to nasal obstruction
- Snoring and sleep apnea with a nasal component
- Septal perforation
- Sequelae of nasal trauma with deformity and obstruction
Aesthetic indications
- Dorsal hump (that "bump" or "lump" on the bridge of the nose)
- Wide, bulbous, or drooping nasal tip
- Crooked or asymmetrical nose
- Wide or disproportionate nose in relation to the face
- Excessively flared nostrils
- Bridge too high or too low
- Aesthetic sequelae of trauma or previous surgery
When I work as a team with an otolaryngologist
In cases of complex nasal obstruction — especially when there is associated chronic sinusitis, nasal polyposis, or the need for functional endoscopic surgery of the paranasal sinuses — I work together with an otolaryngologist. This partnership allows each specialist to take care of their area of expertise: the otolaryngologist treats the sinus disease and I handle the correction of the septum and nasal aesthetics.
This multidisciplinary approach is something I deeply value. The patient benefits from the best of each specialty in a single surgical procedure.
The consultation: complete evaluation of the nose
The consultation for rhinoseptoplasty is detailed and essential. I take time to understand not only what you dislike about your nose but also how it functions. Many patients are surprised to discover during the evaluation that they have significant nasal obstruction to which they have already adapted.
What I evaluate during the consultation
- Complete aesthetic analysis: I examine the nose from the front, profile, and below (basal view), assessing proportions, symmetries, projection and rotation of the tip, width of the bridge, shape of the nostrils.
- Skin thickness: thin skin reveals more details of the structure; thick skin tends to "hide" subtle refinements. This information completely changes the planning.
- Functional evaluation: I examine the nasal septum, turbinates, nasal valves, and mucosa. Airflow tests help quantify the obstruction.
- Cartilaginous and bony structure: I palpate and assess the rigidity of the cartilages, the position of the nasal bones, and the integrity of the septum.
- Global facial analysis: the nose does not exist in isolation. I assess how it relates to the forehead, eyes, upper lip, and chin. Sometimes, a mentoplasty can perfectly complement the result of rhinoseptoplasty.
- Standardized photographs: I take images in multiple positions for detailed surgical planning.
- Medical history: respiratory allergies, use of nasal medications, previous surgeries, trauma, smoking.
Realistic expectations
I am very frank during the consultation. I explain what I can and cannot do. I show examples so that you understand the possibilities and limitations of the surgery. A beautiful nose is one that fits your face, not a copy of someone else's nose. My goal is to create a natural, balanced result with full function.
Preparation for rhinoseptoplasty
Pre-operative exams
I request the following exams before surgery:
- Complete blood count
- PT/aPTT with INR
- Creatinine and BUN
- Fasting blood glucose
- Total proteins and fractions
- Urinalysis
- EKG
- Pre-operative cardiac clearance
- Computed tomography of the sinuses (in cases of significant obstruction or sinusitis)
Medications to be discontinued
Two weeks before and two weeks after surgery, you should discontinue:
- Acetylsalicylic acid (Aspirin, AAS, Bufferin)
- Non-steroidal anti-inflammatory drugs
- High doses of Vitamin E
- Ginkgo biloba and other herbal remedies
- High doses of Omega 3
- Arnica
Smoking should be discontinued for the same period. Nicotine compromises blood circulation in the nasal mucosa and skin, increasing the risk of complications and impairing healing.
Previous clinical treatment
In patients with allergic rhinitis or chronic inflammation of the nasal mucosa, I start clinical treatment a few weeks before surgery with nasal corticosteroids and nasal irrigation with saline solution. A healthy mucosa at the time of surgery contributes to less bleeding and better healing.
The surgery step by step
Rhinoseptoplasty lasts between two and four hours, depending on the complexity of the case and associated procedures. It is performed under general anesthesia in a fully equipped operating room.
Anesthesia and start
After anesthetic induction, I perform local infiltration with an epinephrine solution that reduces bleeding and facilitates dissection. I position nasal tampons with topical anesthetic on the mucosa to enhance vasoconstriction and analgesia.
Correction of the nasal septum
Through an internal incision, I access the nasal septum in its entirety. I remove the deviated portions of cartilage and bone, always preserving a continuous strip of cartilage in an "L" shape that maintains the support of the dorsum and the nasal tip. The removed portions are carefully sculpted and transformed into grafts that I will use in the aesthetic phase.
When the deviation is very pronounced, I may use scoring techniques (small incisions in the cartilage to allow it to change shape), septal molding suture, or repositioning of the septum over the maxillary crest.
Treatment of the turbinates
When there is turbinate hypertrophy, I perform partial inferior turbinectomy — careful removal of excess mucosal and bony tissue from the inferior turbinate. In some cases, I opt for submucosal cauterization, which reduces the volume of the turbinate without removing tissue. The choice depends on the degree of hypertrophy and the anatomy of each patient.
Osteotomies
Osteotomies are controlled fractures of the nasal bones that allow me to narrow the dorsum, correct bony deviations, and close the open roof after reducing the dorsal hump. I use specific osteotomes with millimeter precision. The percutaneous lateral osteotomies leave imperceptible pinpoint scars.
Remodeling the nasal tip
The tip of the nose is the most complex and challenging area. Using precise sutures on the alar cartilages and structural grafts, I shape the tip to achieve the planned projection, rotation, and definition. Each point is strategically positioned to create the desired shape without compromising breathing.
Refinement of the dorsum
If there is a dorsal hump, I remove the excess cartilage and bone with rasps and osteotomes. If the dorsum is low, I position cartilage grafts to elevate it. The spreader grafts are almost always used at this stage, as they not only smooth the dorsum but also widen the internal nasal valve and significantly improve airflow.
Closure and dressing
I bring the septal mucosa together with absorbable sutures and close the columella incision with fine threads that will be removed in a week. I position internal silicone splints to keep the septum in the correct position and apply an external thermoplastic splint molded over the nasal dorsum. Surgical tape complements the immobilization.
Procedures I can combine with rhinoseptoplasty
When the patient desires, or when clinically recommended, I can perform other procedures at the same surgical time:
Mentoplasty: balancing the profile
The chin and nose are the two structures that most influence the facial profile. A retruded chin can make a normal nose appear large. Mentoplasty — advancement or recession of the chin with a silicone implant — is a frequent complement to rhinoseptoplasty and dramatically improves profile balance.
Blepharoplasty: rejuvenating the gaze
Patients who wish to rejuvenate the middle third of the face can combine rhinoseptoplasty with a blepharoplasty, taking advantage of the same anesthesia and recovery.
Otoplasty: correcting the ears
Prominent ears can be corrected simultaneously through otoplasty, taking advantage of the same anesthesia session.
Facial fat graft
The facial fat graft can be combined to improve dark circles, fill grooves, and restore overall facial volume.
Post-operative care after rhinoseptoplasty: what to expect
The recovery from rhinoseptoplasty requires patience. The nose is a structure that heals slowly, and the final result takes months to stabilize. But the good news is that the immediate recovery is more comfortable than most patients imagine.
First 48 hours
You will leave the surgery with an external splint on your nose, internal splints, and surgical tape. There will be swelling around the eyes and, in many cases, bruising (purple spots) on the eyelids. This is normal and does not indicate a complication. Keep your head elevated, apply cold compresses to the periorbital area, and take the prescribed medication strictly.
Unlike what many fear, modern rhinoseptoplasty no longer uses traditional nasal packing. The silicone splints are comfortable and allow some airflow. This makes the post-operative period much more tolerable than it was in the past.
First week
The swelling peaks between the second and third day, then begins to decrease progressively. The bruises change color (purple, yellow, greenish) and disappear in ten to fourteen days. I remove the internal splints in seven days — the procedure is quick and causes only slight discomfort. At this point, most patients report a dramatic improvement in breathing.
Second to third week
I remove the external splint in ten to fourteen days. The nose will still be swollen, but it already presents a pleasant shape. You will be presentable for social activities, although close friends may notice slight residual edema. Light makeup can be used.
First to third month
The swelling gradually subsides. The tip of the nose is the area that takes the longest to de-swell, especially in patients with thick skin. Avoid direct sun exposure, use sunscreen daily, and do not wear glasses resting on the nasal dorsum for at least forty-five days.
Six months to a year
The result progressively refines. The tissues settle, the residual edema disappears, and the scars mature. Patients with thin skin see the almost final result around six months. Thick skin can take up to eighteen months to reveal the definitive result.
Risks and complications: total transparency
Every surgery has risks. I prefer to be completely transparent about them during the consultation so that you can make an informed decision.
Possible complications
- Bleeding: rare when the pre-operative preparation is followed correctly. In the rare cases it occurs, it is usually controlled with temporary packing.
- Infection: extremely rare in nasal surgery, prevented with antibiotic prophylaxis.
- Residual asymmetries: every face has natural asymmetries. Healing can accentuate or create subtle asymmetries that, when significant, can be corrected in revision.
- Persistent nasal obstruction: with the structured technique and simultaneous correction of the septum and turbinates, this risk is minimized, but it can occur due to the formation of synechiae (adhesions) or exuberant healing.
- Aesthetic dissatisfaction: the surgical revision rate in rhinoseptoplasty varies from five to fifteen percent in the global literature. In my practice, I strive to minimize this number with meticulous planning and clear communication about expectations.
- Septal perforation: rare, related to the management of the septum. When it occurs, it can cause nasal crusting and whistling. It can be surgically corrected.
It is important for you to understand: rhinoseptoplasty is one of the most complex surgeries in plastic surgery. Excellent results depend on experience, refined technique, and individualized planning. Therefore, the choice of surgeon is the most important decision you will make.
Rhinoseptoplasty versus non-surgical treatments
In recent years, the so-called "rhinomodeling" with hyaluronic acid filling has become popular. I need to be honest: rhinomodeling can be useful for small aesthetic corrections — camouflaging a subtle hump, discreetly lifting the tip, correcting minimal asymmetry. But it does not replace rhinoseptoplasty in any scenario.
Hyaluronic acid does not correct septal deviation. It does not treat turbinate hypertrophy. It does not improve breathing. And, in the aesthetic context, it always adds volume — which means it makes the nose larger, not smaller. For the vast majority of patients who desire a smaller, more refined, and functional nose, surgery is the only effective path.
Moreover, there are real risks associated with nasal filling, including skin necrosis and even blindness due to vascular embolization. These risks, although rare, are disproportionate for a procedure that offers temporary and limited results.
Rhinoseptoplasty and sleep quality
One aspect that many patients underestimate is the impact of nasal obstruction on sleep quality. When you do not breathe well through your nose, you tend to breathe through your mouth at night. This causes dryness of the oral mucosa, snoring, frequent awakenings, and reduced deep sleep phase.
After rhinoseptoplasty, patients often report a surprising improvement in sleep quality, daytime disposition, concentration ability, and even performance in physical activities. Proper nasal breathing filters, warms, and humidifies the air much more efficiently than oral breathing.
My training and experience
I graduated from the State University of Londrina and had the privilege of being a student of Professor Ivo Pitanguy, the greatest name in Brazilian plastic surgery. I am a full member of the Brazilian Society of Plastic Surgery (SBCP) and the American Society of Plastic Surgeons (ASPS). Over more than twenty years of practice, I have performed over eight thousand plastic surgeries, with extensive experience in functional and aesthetic nasal surgery.
Rhinoseptoplasty requires mastery of detailed surgical anatomy, refined aesthetic sensitivity, and experience to deal with the infinite variations that each nose presents. Each nose is unique, and each surgery is planned individually. There is no one-size-fits-all recipe.
If you are considering rhinoseptoplasty in Brazil, I invite you to schedule a consultation. I will carefully examine your nose, listen to your complaints and desires, and explain exactly what I can do for you. With honesty, technique, and dedication.
Frequently Asked Questions about Rhinoseptoplasty
What is the difference between rhinoplasty and rhinoseptoplasty?
The rhinoplasty is the surgery that modifies the appearance of the nose — its shape, size, and proportions. Rhinoseptoplasty combines this aesthetic correction with the functional correction of the nasal septum and, when necessary, the turbinates. In summary, rhinoseptoplasty addresses two problems in a single surgery: appearance and breathing.
Is rhinoseptoplasty covered by health insurance?
The functional component of the surgery — septoplasty and turbinectomy — may be covered by health plans when there is documentation of significant nasal obstruction, usually proven by CT scan and otolaryngological evaluation. The aesthetic component, however, is not covered. In practice, many patients choose to undergo the procedure privately to ensure a complete and integrated approach.
How long does the surgery last?
Rhinoseptoplasty lasts between two and four hours, depending on the complexity of the case. Severe septal deviations, the need for multiple grafts, extensive osteotomies, or associated procedures such as mentoplasty can prolong the surgical time. The surgery is performed under general anesthesia in an operating room.
Will I need to use nasal packing?
I do not use traditional nasal packing. I use internal silicone splints that are much more comfortable and allow some airflow. This change has made the postoperative period of rhinoseptoplasty much more tolerable. The splints are removed in seven days in the office, quickly and with minimal discomfort.
When will I be able to breathe well after the surgery?
Shortly after the removal of the internal splints, in seven days, most patients already notice significant improvement in breathing. However, the edema of the nasal mucosa may take four to eight weeks to completely subside. Improvement is progressive, and the definitive functional result is established between two and three months.
Does rhinoseptoplasty hurt a lot?
Pain in the postoperative period of rhinoseptoplasty is generally mild to moderate and well controlled with acetaminophen and OTC pain medication. What bothers patients the most is not pain per se, but the sensation of nasal obstruction in the first few days and the swelling around the eyes. These discomforts are temporary and improve quickly.
What is the minimum age to have rhinoseptoplasty?
I recommend that the surgery be performed after the completion of facial growth, which usually occurs around sixteen to seventeen years in girls and seventeen to eighteen years in boys. In cases of severe respiratory obstruction, isolated septoplasty may be recommended earlier, but aesthetic correction should wait for skeletal maturity.
Can I have rhinoseptoplasty if I have had nose surgery before?
Yes. Secondary rhinoplasty or revision is more complex than primary rhinoplasty, as it works with already operated tissues, potentially weakened cartilages, and fibrosis. In these cases, I often need additional cartilage from the ear or, in more complex cases, from the rib. The structured technique is even more important in revision, as it allows for the reconstruction of lost support.
Will the scar from open rhinoseptoplasty be visible?
The incision on the columella heals in a practically imperceptible way. In two to three weeks, it is already difficult to identify it without looking closely. In six months, even up close, it completely blends in with the normal skin. I have never had a dissatisfied patient with this scar.
Can rhinoseptoplasty improve my snoring?
If the snoring has a significant nasal component — which is quite common — rhinoseptoplasty can substantially improve it. Correcting the septal deviation and treating turbinate hypertrophy restores nasal airflow, allowing for adequate breathing during sleep. However, snoring can have other causes (soft palate, base of the tongue, obesity) that should be investigated.
When can I return to physical exercise?
Light walking can be resumed in two weeks. Moderate activities such as light weightlifting can be resumed in three to four weeks. Contact sports, swimming, and intense activities should wait at least six to eight weeks. Any activity that involves a risk of nasal trauma should be avoided for three months.
Can I wear glasses after rhinoseptoplasty?
Glasses should not be supported directly on the nasal bridge for at least forty-five days after surgery, as the pressure can displace the nasal bones before they are fully consolidated. If you wear prescription glasses, I recommend contact lenses during this period or, alternatively, there are special supports that rest the glasses on the forehead, relieving the weight on the nose.
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If you have made it this far, it is because you are seriously considering septorhinoplasty in Brazil. The next step is simple: schedule a consultation with me. As a rhinoplasty specialist in Brazil with over 20 years of experience, I combine functional and aesthetic correction in one operation. My team is ready to assist you, answer your questions, and find the best time for your evaluation -- including support for medical tourism patients traveling to Brazil for nose surgery.
Learn more about the first consultation, the investment, and the guidelines for pre-surgical preparation and post-operative recovery. You may also explore my rhinoplasty, ultrasonic rhinoplasty, and facelift pages.
Are you ready for this new change? Schedule now!
Dr. Walter Zamarian Jr.
Plastic Surgeon in Brazil
Rua Engenheiro Omar Rupp, 186
Londrina - Brazil
ZIP 86015-360
Brazil
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