In short. Airway function is assessed before appearance, and a structural cause changes the plan entirely. Why the two questions are answered together.

Key points

  • A structural obstruction can be corrected during the same operation as an appearance change, and often should be.
  • What it is not is an automatic benefit: work on the profile can affect the airway, occasionally for the worse.
  • A plan that does not say what will happen to your breathing has not addressed half of what the operation does.

A nasal assessment answers two questions, and the order between them is deliberate. The first is whether the nose works; the second is how it looks. They are answered in the same examination, because the findings interact: a structural obstruction changes what an operation has to do, and whether an operation is right at all.

The airway first

Obstruction is assessed by examining the inside of the nose and watching how it behaves on inspiration. A deviated septum, a narrow internal valve and a side wall that collapses inward on breathing are the findings that matter, and each has a structural cause. That matters here because structure is what an operation addresses and what an injectable cannot touch. A patient whose main complaint is a blocked nose is asking a question neither option here answers cosmetically, and it is investigated on its own terms first.

Two questions, one operation

A structural obstruction can be corrected during the same operation as an appearance change, and often should be. What it is not is an automatic benefit: work on the profile can affect the airway, occasionally for the worse. A plan that does not say what will happen to your breathing has not addressed half of what the operation does.

The skin, which limits both options

The thickness and quality of the skin over the nose decides a great deal. Thin skin shows every irregularity beneath it, which makes both options less forgiving: material can be visible through thin skin, and small asymmetries show more clearly. Thick skin conceals irregularities but blunts the definition an operation can create. It also heals differently, and how your skin has responded to previous injury is part of the assessment.

The structure, and the direction of the change

Whether the complaint is one of volume or of structure, which is the finding that decides between the two options here. A dip, a small asymmetry and a shallow angle are volume problems. A hump, a wide bridge, a heavy tip and a nose that drops on smiling are structural. Alongside that, any previous injury, any previous filler and the interval since it was placed.

Proportions, and what the patient actually sees

The nose in relation to the forehead, the lips and the chin, because the change patients most often want is one of proportion rather than of the nose alone. This part is hardest to describe in advance and most worth discussing in a mirror, since a patient who can point to what bothers her gives a far more useful account than one who says the nose is too big.

Signals that a nasal assessment was incomplete

  • The airway was not examined, and breathing was not discussed at all.
  • The direction of the change was not established, so volume and structure were treated as interchangeable.
  • Previous filler was not asked about, or the interval since it was placed.

The useful output is your nose described in two parts: how it works, and what would have to change to alter how it looks. The facial surgery pages cover how the nose relates to the face, and when neither option is right sets out the findings that should stop the conversation.

Related reading

Frequently asked questions

Why is breathing assessed before appearance?

Because a structural obstruction is a medical finding, and one that can be corrected at the same time as an appearance problem if it is identified first. It also changes the plan: a deviated septum or a collapsing valve has to be addressed as part of the operation rather than incidentally, and an operation planned only for appearance can occasionally make breathing worse.

Can I have filler if I also have a blocked nose?

The obstruction should be assessed and treated on its own terms first, because an injectable does not address structure and will not improve it. It is not that filler is forbidden, but that a patient whose main complaint is obstruction is asking a question that neither option here answers directly, and that comes first.

What does the assessment look at besides the profile?

The airway, including the septum and the valves, observed at rest and on inspiration. The thickness and quality of the skin over the nose, which affects what an operation can achieve and how visible an injectable might be. Any previous injury or filler and the interval since it was placed. Whether the nose is still growing, which rules out an operation for the time being. And the proportions of the nose against the rest of the face, which is usually the finding patients care most about and describe least precisely.

Risks & Limitations

  • Nasal filler carries an uncommon and serious risk. Material placed in the nose can enter the blood supply of the skin and injure it, and in the rarest cases reach the circulation of the eye. The nose is treated as a high-risk area for this reason.
  • Injecting can only add volume. It cannot make a nose smaller, remove a hump, narrow a bridge or reduce a tip, and adding volume to a nose that is already large makes it larger.
  • Filler is absorbed over months, so maintaining the change means repeating the treatment. The long-term behaviour of volume added to the same nose repeatedly over years is not well described in the literature.
  • Dissolving material with an enzyme usually works, particularly when used early, but it does not always remove everything and does not guarantee that the tissue returns to its previous shape.
  • Rhinoplasty is an operation on the face and carries the risks of one: bleeding that may require a return to theatre, infection, poor healing, asymmetry and altered sensation.
  • Breathing may change after an operation and is not guaranteed to improve. An operation performed only for appearance can occasionally worsen it.
  • Revision after rhinoplasty is a real possibility rather than a rare one. It is a further operation on tissue that has already been operated on, longer and with added risk, and it cannot restore the original nose.
  • Neither option is guaranteed. How a nose settles, how long an injectable lasts and how the skin responds vary between individuals, and no result can be promised in advance.

When to Seek Care

  • Pain, blanching or dusky discolouration of the skin after nasal filler, or any change in vision — this needs immediate attention.
  • Increasing redness, swelling, warmth or discharge after either treatment, particularly with a fever.
  • Bleeding that does not settle, or a collection of blood under the skin that is enlarging.
  • Difficulty breathing that is new or worsening after an operation, or a nose that is obstructed on one side.
  • A change in the shape of the nose after an injury, or a nose that becomes painful and red some time after treatment.
  • Numbness or altered sensation that persists, or a scar that is thickening rather than settling.

References & Further Reading

  • American Society of Plastic Surgeons (ASPS) — rhinoplasty and injectable safety guidance
  • International Society of Aesthetic Plastic Surgery (ISAPS) — global standards of practice
  • National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
  • Cochrane Library — systematic reviews in nasal surgery and injectable complications

Medically reviewed by Ke He, MD (何锞), Deputy Director & Head of Skin & Laser Aesthetics. Last reviewed: 19 September 2026.

This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.