What Is Functional Rhinoplasty?
Functional rhinoplasty is surgery to correct internal structural abnormalities of the nose that impair nasal airflow. The procedure addresses the anatomy causing the obstruction — not the external shape of the nose.
It may involve correction of:
- Deviated septum — the most common cause of nasal obstruction. Septoplasty, performed as part of functional rhinoplasty, straightens the septum to restore airflow through both nasal passages. See septoplasty for a full explanation of this procedure.
- Nasal valve collapse — the nasal valves are the narrowest points of the nasal airway. When they are weak or collapse on inhalation, airflow is severely restricted. Spreader grafts or batten grafts are used to reinforce and widen this area.
- Inferior turbinate hypertrophy — the turbinates are bony structures inside the nasal passages that humidify and filter air. When chronically enlarged, they worsen obstruction. Turbinate reduction may be performed as part of functional rhinoplasty or, where combined with cosmetic rhinoplasty, at a subsequent stage.
- Nasal obstruction from previous surgery — prior rhinoplasty that has left structural compromise affecting breathing. This falls under revision rhinoplasty; see revision rhinoplasty for detail.
Functional vs Cosmetic Rhinoplasty — Understanding the Difference
Functional rhinoplasty addresses internal structural problems affecting nasal airflow. There may be no visible change to the external appearance of the nose, depending on what is involved. Where the procedure is medically indicated, Medicare rebates may apply to certain components.
Cosmetic rhinoplasty addresses the external shape, size, and structure of the nose for aesthetic purposes. It is not covered by Medicare.
These are not mutually exclusive. Many patients have both functional and cosmetic concerns, and both can be addressed in a single operation — septorhinoplasty. This is often the preferred approach where both concerns are present, as it avoids a second operation, a second anaesthetic, and the surgical complexity of operating on a nose that has already had structural work performed. See cosmetic rhinoplasty for a full explanation of the cosmetic side.
Are You a Suitable Candidate?
Functional rhinoplasty may be appropriate if you:
- Experience persistent difficulty breathing through one or both sides of your nose not adequately addressed by medication
- Have been diagnosed with a structural nasal problem — deviated septum, nasal valve collapse, or turbinate hypertrophy — that is contributing to your symptoms
- Experience chronic congestion, frequent mouth breathing, disrupted sleep, or snoring attributable to nasal obstruction
- Have suffered nasal trauma and developed subsequent breathing difficulties
- Have had previous nasal surgery with an unsatisfactory functional result
- Are in good general health with no conditions that significantly increase surgical risk
- Are a non-smoker, or can cease smoking well before surgery
Suitability is assessed during a thorough in-person consultation. Dr Turner will examine your nasal anatomy internally and externally, review your symptom history, and advise on what surgical approach, if any, is appropriate for your situation.
Medicare and Functional Rhinoplasty
Where functional rhinoplasty addresses documented nasal obstruction that meets clinical criteria, Medicare rebates may apply to certain surgical components. Relevant Medicare Benefits Schedule item numbers include:
- 41671 — Septoplasty / submucous resection for deviated septum
- 45632 — Rhinoplasty, partial, involving correction of nasal cartilages
- 45635 — Rhinoplasty, partial, involving correction of the bony vault
- 45641 — Rhinoplasty, total, including correction of all bony and cartilaginous elements (with or without local graft)
- 45644 — Rhinoplasty, total, with distant donor site graft (e.g., rib cartilage)
For a rebate to apply:
- A GP referral confirming the functional indication is required
- Clinical documentation including photographic or NOSE Scale evidence must be recorded
- The procedure must meet the specific criteria attached to the relevant item number
The Medicare rebate applies to the surgical component only. Anaesthesia and hospital fees remain out-of-pocket costs, and a gap payment is typically expected even where a rebate applies. Private health insurance may cover the private hospital component where Medicare criteria are met.
Dr Turner’s team will advise on Medicare eligibility and likely out-of-pocket costs at consultation. For a detailed overview, see Will Medicare Cover My Nose Surgery?
For current pricing, see the rhinoplasty cost guide.
How Functional Rhinoplasty Is Performed
Functional rhinoplasty is performed under general anaesthetic in an accredited private hospital facility. Operating time varies from one to three hours depending on what is involved and whether cosmetic components are being addressed simultaneously.
Septoplasty Component
An incision is made along the inner border of the septum entirely inside the nostril — no external incision, no external scarring. The mucosa covering the septum is lifted, and the deviated cartilage and bone are reshaped, repositioned, or removed to straighten the airway. Absorbable sutures close the incision, and soft silicone splints may be placed temporarily inside the nose to support healing.
Nasal Valve Surgery
Spreader grafts — thin cartilage strips placed along the upper lateral cartilages — widen the internal nasal valve angle. Batten grafts strengthen and support the external nasal valve where collapse is occurring. These grafts are typically harvested from septal cartilage.
Turbinate Reduction
Where enlarged turbinates are contributing to obstruction, they may be reduced in size through submucosal resection or cauterisation. Where combined with cosmetic rhinoplasty, Dr Turner’s preference is to perform turbinate reduction at a subsequent stage — approximately six months post-operatively — once the nose has fully settled.
Combined Septorhinoplasty
Where functional and cosmetic goals are addressed together, the procedure is approached via an open rhinoplasty incision — through the columella — giving direct access to both the internal septum and the external nasal framework simultaneously.
- Correcting the Septum: A septoplasty is performed to straighten a deviated septum, which is a common cause of nasal obstruction.
- Nasal Osteotomies: Precise bone cuts are made using ultrasonic piezotome instruments, this allows for accurate reshaping of the nasal bones with minimal trauma to surrounding tissues, reducing postoperative swelling and bruising.
- Correct Nasal Valve: Spreader grafts are inserted to widen the internal nasal valve area, preventing collapse during inhalation and enhancing nasal airflow.
- Tip Position and Stability: Septal extension grafts (columella grafts) are used to support the new nasal tip position. These grafts provide structural stability, ensuring the tip maintains its desired shape over time.
- Tip Refinement: Modification to the nasal tip cartilages is performed by a variety of techniques such as excising excess cartilage, tip sutures and strengthening cartilage grafts. This allows Dr Turner to shape the nasal tip, reduce bulbosity and improve symmetry.
The Consultation and Regulatory Process
GP referral — required before proceeding toward surgery, and necessary for Medicare eligibility.
Consultation with Dr Turner — a thorough review of your nasal anatomy, breathing symptoms, and functional concerns. Nasal endoscopy or CT imaging may be used where indicated.
AHPRA regulatory requirements (where cosmetic rhinoplasty is combined): Where functional rhinoplasty is combined with cosmetic rhinoplasty, the cosmetic component is subject to the full AHPRA cosmetic surgery requirements effective 1 July 2023:
- Minimum two consultations with Dr Turner before surgery is booked
- A psychological evaluation to confirm suitability for the cosmetic component
- A mandatory cooling-off period before formal consent is given
Standalone functional procedures follow a different regulatory pathway. Dr Turner’s team will clarify which requirements apply based on your individual situation.
Recovery
Recovery from functional rhinoplasty follows a similar timeline to other rhinoplasty procedures:
- Week 1: Internal splints in place if used. Nasal congestion and mild discomfort are expected — temporary worsening of breathing at this stage is normal due to internal swelling. Rest is important.
- Splint removal (approximately day 7–10): Many patients notice immediate improvement in breathing at this point.
- Weeks 2–3: Most patients return to desk-based work. Avoid blowing the nose forcefully.
- Weeks 4–6: Strenuous activity and contact sport avoided. Light activity can resume.
- Months 2–3: Full functional improvement in nasal airflow typically becomes apparent as internal swelling completely resolves.
Where cosmetic rhinoplasty is combined, the recovery follows the longer rhinoplasty timeline — with final cosmetic results at 12 months.
Risks and Complications
Functional rhinoplasty is generally considered safe, but all surgery carries risk. Specific risks include:
- Bleeding during or after surgery
- Infection
- Adverse reaction to anaesthesia
- Septal perforation — uncommon; may require further surgery if symptomatic
- Persistent nasal obstruction — symptoms may not fully resolve in all cases
- Adhesions — scar tissue formation inside the nose
- Altered sense of smell — typically temporary
- Need for revision surgery
- Where combined with cosmetic rhinoplasty: asymmetry, scarring, unsatisfactory cosmetic result, altered nasal airflow
Dr Turner will discuss the risks specific to your anatomy and proposed approach at consultation.
Related Procedures
- Septoplasty — standalone deviated septum correction
- Cosmetic Rhinoplasty — reshaping the external nose
- Revision Rhinoplasty — secondary rhinoplasty
- Teen Rhinoplasty — functional and cosmetic rhinoplasty in adolescent patients
Frequently Asked Questions
What is the difference between functional rhinoplasty and septoplasty?
Septoplasty is a specific procedure that corrects a deviated nasal septum only. Functional rhinoplasty is a broader term covering surgery that addresses any structural nasal problem affecting breathing — which may include septoplasty, nasal valve surgery, turbinate reduction, or a combination. In practice, functional rhinoplasty often incorporates septoplasty as one component. Both are functional procedures and may attract Medicare rebates where clinical criteria are met. Neither changes the external appearance of the nose when performed as standalone procedures.
Will functional rhinoplasty change how my nose looks?
Isolated functional rhinoplasty — addressing internal structures only — does not typically change the external appearance of the nose. Where spreader grafts are placed for nasal valve repair, there may be a subtle widening of the mid-vault, but this is generally minor. Where functional rhinoplasty is combined with cosmetic rhinoplasty (septorhinoplasty), external changes are part of the surgical plan. If you have only functional concerns and no cosmetic goals, the procedure can be performed without altering the external shape.
Does Medicare cover functional rhinoplasty in Australia?
A Medicare rebate may apply where functional rhinoplasty is performed for a documented, clinically indicated reason — such as a deviated septum or nasal valve collapse causing meaningful obstruction. The relevant item numbers include 41671 for septoplasty and 45641 for total functional rhinoplasty. A GP referral is required and the clinical need must be documented. The rebate covers the surgical component only — anaesthesia and hospital fees remain out-of-pocket and a gap payment is typically expected. Dr Turner’s team will advise on eligibility at consultation.
Can functional rhinoplasty and cosmetic rhinoplasty be done at the same time?
Yes — and this is often the recommended approach where both concerns are present. Combining them in a single operation (septorhinoplasty) means one anaesthetic, one recovery, and preserves the septal cartilage needed for rhinoplasty grafting. Performing them sequentially means the first operation depletes cartilage resources for the second, adding complexity. The regulatory requirements for the cosmetic component still apply — including psychological evaluation and cooling-off period — even when combined with a functional procedure.
How long until I notice improved breathing after functional rhinoplasty?
Many patients notice an immediate improvement in breathing once internal splints are removed, usually at approximately one week. Some degree of temporary worsening in the first week is expected due to swelling — this is normal. The full functional improvement typically becomes apparent over two to three months as internal swelling completely resolves. Individual results vary depending on the nature of the obstruction, what was corrected, and how the nasal tissues heal.
Consult with Dr Scott J Turner
Dr Turner consults for functional rhinoplasty in Sydney at Bondi Junction and Manly. He also sees patients in Brisbane, Canberra, Newcastle, and the Gold Coast. Surgery is performed in Sydney at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.
Contact the practice to arrange a consultation, or read more about Dr Turner’s background and training.
Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney Clinic | DrTurner.com.au
