Functional Rhinoplasty
All surgery involves risks and individual results vary. Decisions about whether to proceed should be made after careful consideration and following at least two consultations with a qualified medical practitioner.
Functional rhinoplasty is rhinoplasty performed to improve nasal function rather than — or in addition to — changing the external appearance of the nose. The primary goal is improving the nasal airway, though functional and cosmetic goals can be addressed simultaneously in the same procedure when both are present. Because the nasal septum, the nasal valves, and the external nasal framework are all structurally interdependent, correcting a functional problem frequently requires the same open surgical approach and cartilage grafting techniques used in cosmetic rhinoplasty.
Functional rhinoplasty in Australia is performed by Specialist Otolaryngologists and Head and Neck Surgeons with subspecialty training in rhinoplasty. The functional component may attract Medicare and private health insurance rebates where the clinical criteria are met.
All surgery carries risks — read the full rhinoplasty risks page →
Indications — When Is Functional Rhinoplasty Needed?
Functional rhinoplasty addresses structural problems of the nose that impair breathing or contribute to other nasal symptoms. The conditions most commonly treated include the following.
Nasal Valve Collapse
The nasal valve — internal or external — is the narrowest and most flow-limiting part of the nasal airway. When the supporting cartilages of the valve are weak, the sidewalls of the nose collapse inward during inspiration, obstructing airflow. Patients often notice that holding the skin on the side of the nose outward, or using nasal dilator strips such as Breathe-Right, temporarily improves their breathing — this is a reliable sign of nasal valve collapse. Functional rhinoplasty addresses this with cartilage grafts (alar batten grafts or lateral crural strut grafts) that restore support and prevent collapse.
Severe or Dislocated Nasal Septum
A severely deviated or dislocated nasal septum — where the cartilage has buckled, fractured, or displaced significantly from its normal position — may not be adequately correctable through standard septoplasty alone. In these cases, a functional rhinoplasty approach allows the septum to be fully mobilised, reshaped, and in some cases removed and reconstructed before reinsertion, producing a straight, structurally sound result that a more limited approach cannot achieve. The open rhinoplasty approach also allows placement of spreader grafts to correct middle vault deformity and restore the internal nasal valve where it has been compromised by the septal deviation.
Septal Perforation
A large perforation in the nasal septum can cause significant nasal obstruction, crusting, bleeding, and a whistling sound with breathing. Repair of a significant septal perforation requires a functional rhinoplasty approach to provide adequate access and tissue for closure.
Middle Vault Collapse
Collapse or deformity of the middle third of the nose — whether from trauma, previous surgery, or the inverted-V deformity following dorsal hump reduction — narrows the internal nasal valve and obstructs breathing. Spreader grafts placed along the dorsal septum between the upper lateral cartilages restore the middle vault width and correct the valve angle, improving both the appearance and the function of the nose.
Nostril Stenosis
Narrowing of the nostril opening — whether congenital or from scarring after previous surgery or injury — can severely restrict nasal airflow. Surgical correction involves releasing the scar tissue and placing grafts to maintain the opening.
Relationship to Snoring and Sinus Problems
Nasal obstruction is a contributing factor in snoring and obstructive sleep apnoea — mouth breathing during sleep destabilises the pharyngeal airway and worsens upper airway collapse. Correcting nasal valve collapse or severe septal deviation can reduce snoring severity and, in patients using CPAP for sleep apnoea, improve mask tolerance and compliance by allowing nasal breathing.
Severe septal deviation can also obstruct the ostiomeatal complex — the drainage pathway through which the sinuses drain into the nasal cavity — predisposing to recurrent sinus infections. Functional rhinoplasty addressing the septal deviation can improve sinus drainage. Where significant sinus disease is also present, functional endoscopic sinus surgery (FESS) may be performed at the same time.
The Surgical Procedure
Functional rhinoplasty is generally performed through an open approach — a small incision across the columella (the skin between the nostrils) that allows the nasal skin to be elevated and the underlying cartilage framework to be directly visualised and worked on. This approach provides the access necessary for accurate cartilage grafting and structural reconstruction that a closed approach does not allow.
The procedure typically combines septoplasty or nasoseptal reconstruction with inferior turbinate reduction, and then places one or more cartilage grafts to restore structural support to the airway. The grafts most commonly used include spreader grafts (to widen the internal nasal valve and correct middle vault deformity), alar batten grafts and lateral crural strut grafts (to support the external valve and prevent sidewall collapse), rim grafts, and columellar strut grafts. Cartilage is harvested from the nasal septum where available, or from the ear or rib where additional graft material is required.
Where cosmetic concerns are also present, these can be addressed in the same operation. A combined functional and cosmetic rhinoplasty — septorhinoplasty — allows both goals to be achieved in a single anaesthetic, and ensures that the structural changes required for functional correction are planned with the external appearance in mind.
Read more about functional rhinoplasty and Medicare eligibility → | Nasal valve collapse →
Medicare and Health Insurance
Functional rhinoplasty performed for documented nasal airflow obstruction may attract Medicare and private health insurance rebates for the surgical, anaesthetic, and hospital components. The specific MBS item numbers applicable depend on the procedures performed and the clinical indication.
Patients should be aware that some Australian health funds — including Medibank Private — allow policy holders to remove “Plastic and Reconstructive Surgery” from their coverage to reduce premiums. Functional rhinoplasty performed by a Specialist Otolaryngologist for breathing, snoring, or sinus indications is classified by these funds under “Plastic and Reconstructive Surgery.” If your policy excludes this category, you will not have hospital cover for functional rhinoplasty. It is worth checking your level of cover with your health fund before consultation if you are uncertain.
Medicare does not cover purely cosmetic rhinoplasty. Where a procedure addresses both functional and cosmetic goals, the functional component may attract a rebate and the cosmetic component does not.
Dr Roth’s Clinical Perspective
The distinction between functional and cosmetic rhinoplasty is somewhat artificial in practice. The nose is a single structure and the same techniques — open approach, cartilage grafting, structural reconstruction — are used for both goals. What differs is the primary indication and what Medicare will contribute to. In my practice, a significant proportion of patients presenting for cosmetic rhinoplasty also have a septal deviation, nasal valve compromise, or turbinate hypertrophy that is worth addressing at the same time. Doing so does not add meaningful risk, improves the functional outcome, and in many cases produces a better cosmetic result because a properly supported nasal framework holds its shape better long term.
For patients presenting primarily for functional reasons — breathing improvement, snoring reduction — the consultation process is the same as for cosmetic rhinoplasty: a detailed internal and external examination, discussion of what can and cannot be achieved, and an honest conversation about what surgery involves and what recovery entails. Functional rhinoplasty is real surgery with real recovery, and patients who understand this in advance have better experiences than those who were told it was a simple procedure.
— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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