Are Pre-Surgery Online Consultations Sufficient? Endoscopic Examination, Tomography and Functional Assessment Before Rhinoplasty | Explained by Prof. Dr. Gediz Murat Serin
Nose aesthetics (rhinoplasty) or revision rhinoplasty is one of the most frequently performed aesthetic surgeries today. However, another issue as important as aesthetic appearance is the healthy functioning of nasal functions. When functional problems are neglected, patients may complain of not being able to breathe comfortably through their nose even after a seemingly successful surgery. At this point, detailed ENT examination before rhinoplasty, especially endoscopic evaluation, plays a vital role.
Why Are Online Evaluations Not Sufficient?
With the development of technology, online preliminary consultations, photo analyses and digital planning have become widespread. However, none of these methods give us information about the internal structures of the nose. Nasal turbinates (conchae), septum deviation, sinus cavities and channels opening into the nose, and even pathologies in the nasopharynx region can only be revealed through endoscopic examination.
Sinuses, Nasal Turbinates and Septum: Invisible But Felt Problems
During rhinoplasty, septum deviation is usually corrected because this area is accessed to obtain grafts during surgery. Additionally, nasal turbinates, namely inferior turbinate hypertrophy, cause serious nasal congestion and must definitely be addressed.
More importantly, the condition of the sinuses is always overlooked. However, if conditions such as chronic sinusitis exist and are not noticed, the patient may continue to experience serious problems after surgery.
“A situation I frequently encounter in my practice: Patients apply for aesthetic purposes, but during detailed endoscopic examination, we detect serious edema, mucus accumulation or even polyps at the sinus opening. In this case, performing only rhinoplasty does not provide a long-term solution.”
— Prof. Dr. Gediz Murat Serin
I Can’t Breathe After Rhinoplasty, Why?
Some patients may be aesthetically satisfied after rhinoplasty surgery but may experience complaints of not being able to breathe through their nose. An important reason for this is that adequate functional evaluation was not performed before surgery. If the nasal turbinates are enlarged (turbinate hypertrophy), if there is chronic inflammation at the sinus opening, or if problems such as adenoids in adults are ignored, the patient will continue to experience breathing problems even though they have an aesthetically beautiful nose. Therefore, it is essential that aesthetic and functional approaches are evaluated together in rhinoplasty planning.
Are Rhinoplasty and Sinusitis Surgery Performed Together?
Sinusitis surgery is not part of rhinoplasty; it is a procedure in its own right. However, if there is existing chronic sinusitis before rhinoplasty and the patient’s symptoms are evident, it is possible to plan both surgeries together in the same session.
Do Adults Have Adenoids?
Yes, adenoid hypertrophy can also be seen in adults. This condition, which is thought to belong to childhood, may remain unreduced in some adult individuals and may increase nasal congestion. Such conditions can also only be detected through endoscopic examination.
Septum Perforation Should Not Be Overlooked Either
In some patients, especially those who have previously undergone nasal surgery, septum perforation may also be seen. This condition may usually not be noticed by patients, but is clearly detected in detailed endoscopic examination. A hole (perforation) formed in the septum can cause both functional and aesthetic problems. It can cause complaints such as dryness, crusting, and bleeding inside the nose. This actually requires separate surgical planning and intervention like a procedure in its own right.
Is Tomography Necessary?
If problems are seen at the sinus openings during endoscopic examination, sinus tomography is requested. However, there is no need to take tomography in every patient. The primary and most accurate approach is endoscopic nasal examination with camera.
In Summary:
- Functional evaluation is as important as aesthetic planning.
- Endoscopic examination enables clear evaluation of intranasal structures.
- Conditions such as sinusitis, nasal turbinates (conchae), deviation, perforation meaning intranasal hole, and adenoids should be detected before rhinoplasty.
- Tomography should only be requested for patients when deemed necessary.
- Diagnosis should be made with camera, not with the eye.
Prof. Dr. Gediz Murat Serin’s Note
“I have been performing both aesthetic and functional nasal surgeries for over 20 years. Rhinoplasty is not just an aesthetic intervention; it is a step that improves the patient’s breathing quality and raises their living standards. That’s why I definitely perform detailed endoscopic examination on all my patients before surgery.”
