Difficulty breathing is not always caused solely by a deviated nasal septum; Nasal surgery techniques have evolved and now aim to preserve, reposition and reshape the structures of the nose, using reconstruction when necessary; Rhinoseptoplasty can improve breathing and, when indicated, correct changes in the shape of the nose; The instruments available for nasal surgery have also evolved, allowing surgeons to work on nasal structures in a more controlled and precise manner; Each procedure should be planned individually, taking into account the patient’s anatomy, respiratory function and the goals of the intervention. Breathing well also depends on the structure of the nose Breathing through the nose is a natural process, so automatic that we rarely think about its importance until something interferes with this function. Persistent nasal obstruction can significantly affect quality of life, interfering with sleep, physical exercise, concentration and everyday well-being . Sleeping with the mouth open, having difficulty breathing during physical activity or experiencing a constantly blocked nose are situations that many people come to regard as normal, without recognizing the impact they can have on daily life. However, not all breathing difficulties are caused by a deviated nasal septum . In some cases, they are related to changes in the structure of the nose itself, particularly its shape or configuration, or weakness in the cartilage that provides structural support. In these situations, rhinoseptoplasty can play a particularly important role. What is rhinoseptoplasty? Rhinoseptoplasty is a surgical procedure that combines correction of the nasal septum with surgery on the external structure of the nose. Its purpose may be to improve breathing and, when indicated, also to correct the shape and appearance of the nose. Function and appearance are therefore not necessarily separate issues. The anatomy of the nose determines its shape, contributes to its structural support and also plays a role in respiratory function. How has nasal surgery evolved? Nasal surgery has evolved significantly over recent decades. This evolution has been driven by an increasingly detailed and precise understanding of the anatomy and function of the nose, as well as a greater appreciation of the importance of preserving the structures responsible for its support and stability. For many years, some rhinoplasty techniques were based primarily on removing cartilage and bone to modify the size or contour of the nose. These approaches made it possible to treat many deformities, but experience has also shown that excessive removal of these structures can compromise nasal support and, in some situations, contribute to changes in respiratory function or even in the shape of the nose. Modern surgery therefore aims to go beyond the simple removal of structures. Preserving, repositioning, reshaping and, when necessary, reconstructing are now fundamental principles of an approach designed to achieve natural, long-lasting and functional results. What is dorsal preservation? Among the concepts that have gained prominence in rhinoplasty are preservation techniques, particularly dorsal preservation . The nasal dorsum is the region extending from the root to the tip of the nose and plays a key role in the profile and overall harmony of the face . Its shape is determined by the relationship between different bony and cartilaginous structures, the integrity of which also contributes to the support and stability of the nose. In more traditional approaches, reducing a prominence of the nasal dorsum often involves removing part of the structures that form it. In selected cases, preservation techniques make it possible to modify the position or configuration of these structures while aiming to maintain the anatomical continuity of the dorsum and preserve nasal support as much as possible. This approach requires careful assessment of the anatomy and characteristics of each individual nose. Preservation techniques are not suitable for every case, so the choice of surgical approach should always be individualized. Instruments that enable more precise surgery It is not only nasal surgery techniques that have evolved. The instruments available for operating on the structures of the nose have also become increasingly sophisticated. One example is the piezoelectric system, which uses ultrasonic microvibrations to perform certain bone cuts and reshaping procedures. This technology makes it possible to work on bony structures in a particularly controlled manner and can be useful in procedures such as osteotomies (cuts made in the bone to allow it to be mobilized or repositioned) and reshaping of the nasal dorsum . The use of this technology can contribute to a more precise approach to bony structures while aiming to reduce trauma to adjacent tissues. However, technology is only a tool. Its use and benefits depend on the surgical technique, the characteristics of each individual case and the experience of the surgeon. Preserving, correcting and reconstructing when necessary The evolution of rhinoplasty can therefore be understood as a gradual shift from surgery predominantly based on the removal of structures towards an approach increasingly focused on preservation, precision and, when necessary, reconstruction. The aim is to achieve a structurally balanced nose, with a natural result tailored to the characteristics of each person’s face, without losing sight of its primary function: breathing . Author : Roberto Estevão Meet the otorhinolaringology team of the Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item. English translation generated with AI and reviewed by the editorial team.
