Functional Nasal Surgery

Form and function: the inseparable duo of rhinoplasty

The first segment of the airway performs many functions, some of which vital. The nose is responsible for triggering immune responses to inhaled micro-organisms, the sense of smell, regulation of air humidity and temperature. The term “functional nasal surgery” refers to improving respiratory problems rather than altering the external appearance of the nose. However, the intimate relationship between form and functions makes separation of these interwoven factors practically impossible.

The innate relationship between the shape of the nose and its function translates into the inability to segregate these 2 factors. Therefore, rhinoplasty cannot be simply considered a “retouching” of the external appearance. The rhinoplasty surgeon carefully plans, and executes the minutest detail of the operation based on the principle of the inseparability of shape and function.

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Nasal functional surgery: septum, turbinates and valve correction

The multimodality of nasal function increases the complexity of surgical modification. Unlike purely cosmetic surgery, almost every nasal operation involves functional repercussions. Therefore, ‘combined corrective surgery’ more accurately describes the twofold, complex nature of rhinoplasty/septorhinoplasty. The rigid dualism between cosmetic and functional surgery is simply not a valid viewpoint.

Combined surgical correction includes septoplasty, whose complexity largely depends on reconstructive maneuvers. Post-traumatic or post-surgical cases (revisions or secondary rhinoplasty) are the most demanding in this regard. The incision for septoplasty is usually internal, immediately behind the columella (hemitransfixion incision).

Whenever possible, the surgeon should opt for a minimally-invasive approach: laser or radiofrequency under endoscopic control are the preferred treatment for turbinate hypertrophy. Alternatively, the surgeon can reduce the internal volume of the turbinates or the bone with motorized instruments called debriders.

The correction of nasal valves often requires autologous cartilaginous grafts taken from the nasal septum when available, or from the auricular hollow, and – in a very small minority of cases – the rib from the same subject.

Nasal functional surgery: every case is unique in the “hybrid” approach of Dr. Palma (YOUnique Rhinoplasty™)

Every rhinoplasty is a one-of-a-kind operation as each nose is different. Every patient’s wish list for change is unique. The rhinoplasty surgeon has to master facial analysis and utilise a vast array of techniques that are aimed at patient-specific problems.

Having overcome the classic dichotomy between external or “open” rhinoplasty and endonasal or “closed” rhinoplasty, Dr. Palma emphasizes the unique nature of each patient’s preferences for change. Every rhinoplasty is YOUnique Rhinoplasty

In Hybrid Rhinoplasty, the number and location of the endonasal incisions vary according to the targets defined in the pre-operational phase. Patient-specific anatomical “corridors” offer variable avenues to the surgeon, provide a visual field comparable to the open technique, and leave no visible scars on the columella.

Nasal functional surgery in Milan with Dr. Pietro Palma

The recent evolution of anatomical knowledge, surgical techniques, and technologies, set the scene for minimally invasive techniques that reduce collateral damages thanks to the increasing specificity of anatomical targets. Currently, the trend in general surgery and rhinoplasty (both revision and complex cases) emphasizes the importance of preserving natural structures and reducing invasiveness. The specialist rhinoplasty surgeon, having dedicated decades of personal development and experience to this complex operation has the privilege of designing and performing a patient-specific nose operation.

A leading Italian rhinoplasty expert, Dr. Pietro Palma has been carrying out intense didactic and professional activities at the international level for over 25 years. He has acquired a super-specialization in rhinoplasty. Firmly believing that the mastery of any form of art – such as rhinoplasty in its most refined form is – requires a complete and unconditional dedication, his surgical practice has focused exclusively on rhinoplasty and nasal surgery for corrective, functional, reconstructive and plastic purposes. The outcome of his approach is crucial in determining the patient’s quality of life. 

For detailed and personalized information on rhinoplasty, septoplasty and their costs, please feel free to arrange a preliminary interview contacting Clinica del Viso (Piazza Repubblica, 21 – Milan – Tel +390263611932 – or Private Hospital “LA MADONNINA” (Via Quadronno, 29/31 – Milan – Tel +390258395555 –