A deviated nose is really two separate problems: an internal septum that blocks airflow, and an external shape that looks crooked. Dr. Richard Westreich developed Foundation Rhinoplasty™ to correct both in a single procedure, rather than leaving the visible asymmetry behind after a standard septoplasty. This blog explains what sets the technique apart, who benefits most, and what patients can expect from consultation through full recovery.
What Is Foundation Rhinoplasty™?
Foundation Rhinoplasty™, also referered to as Polish Rhinoplasty, is a technique developed by Dr. Westreich that treats the nasal septum as the structural base of the entire nose, correcting the deviation at its source rather than masking it from the outside. Because the septum acts as the internal scaffolding for the bridge and tip, straightening it first can help the external shape settle into a more natural alignment.
Facial symmetry is also taken into account and its specific effects on nasal position are evaluated. Directed techniques such as sub alar grafting and nasal base suspension are used in the lower nose. Techniques such as double lateral ostomies are used in the upper nose, for bony platform asymmetries. These techniques are combined with septal correction and structural cartilage grafting to produce a straighter, more functional and stronger nasal form.
Asymmetry is rarely limited to the nose on its own. A study published in the Aesthetic Surgery Journal found that among patients presenting for rhinoplasty, 70% had asymmetric midfaces and 68% had deviated nasal bones, suggesting that facial asymmetry often drives nasal deviation rather than the other way around.
The Foundation Rhinoplasty technique grew out of Dr. Westreich's peer-reviewed research on deviated nose correction. A 2006 publication in Archives of Facial Plastic Surgery, co-authored by Ammar, Westreich, and Lawson, documented the Fan Septoplasty method for correcting noses with both internal and external deviation. That study helped establish the closed, foundation-first philosophy that Dr. Westreich continues to refine in his Manhattan practice today. Other subsequent publications about subalar grafting, facial asymmetry analysis, and nasal surgery techniques added to the approach.
Unlike a purely cosmetic approach that shaves or reshapes visible cartilage, Foundation Rhinoplasty™ starts underneath the surface. Cartilage and bone are repositioned and stabilized before any cosmetic refinement takes place, which may support longer-lasting results and may lower the chances of the deviation reappearing over time.
How Foundation Rhinoplasty™ Differs from Standard Septoplasty
Septoplasty and Foundation Rhinoplasty™ both target a deviated septum, but they solve different problems. A patient choosing between the two should understand what each procedure actually changes.
| Factor | Standard Septoplasty | Foundation Rhinoplasty™ |
|---|---|---|
| What is corrected | Internal septal deviation only | Internal septal deviation and external nasal shape |
| Cosmetic changes included | No | Yes, integrated into the same surgery |
| Recovery time | Roughly one to two weeks | Similar timeline, with gradual cosmetic swelling reduction over several months |
| Best candidate | Patients with breathing issues and no cosmetic concerns | Patients with both breathing issues and a visibly crooked or asymmetric nose |
| Addressing the root cause | Corrects the septum but may leave outer asymmetry visible | Rebuilds the septal foundation so the external shape corrects naturally |
Choosing septoplasty alone can leave a patient breathing more easily while still looking in the mirror at a crooked nose, since the procedure was never designed to touch the outer structure. Foundation Rhinoplasty™ closes that gap by treating the septum as one connected system with the nasal exterior, so a single operation resolves both concerns.
Who Is a Candidate for Foundation Rhinoplasty™?
Foundation Rhinoplasty™ tends to suit patients who have outgrown the limits of a standard septoplasty because their concerns extend beyond breathing alone. Dr. Westreich generally considers the following patients strong candidates:
- Patients with a documented internal septal deviation who are also unhappy with the visible shape or symmetry of their nose
- Patients with a history of nasal trauma, such as a broken nose from an accident or sports injury, that has affected both function and appearance
- Patients experiencing breathing obstruction alongside a nose that appears crooked, twisted, or asymmetric from the front
- Patients who want their functional and cosmetic goals addressed in one surgery and recovery period rather than two separate procedures
Candidates should be in good general health, have realistic expectations about the outcome, and be prepared for a recovery process similar to a standard rhinoplasty. A consultation with Dr. Westreich, including a physical exam and airflow evaluation, confirms whether Foundation Rhinoplasty™ or an alternative approach fits the individual's anatomy.
The Foundation Rhinoplasty™ Procedure: Step by Step
Every Foundation Rhinoplasty™ begins with a thorough diagnostic process and follows a sequence designed to correct the nose from the inside out.
- Evaluation and airflow testing: Dr. Westreich examines the internal septum and external nasal structure, often alongside airflow testing, to map the full extent of the deviation and how it affects breathing.
- Establishment of the septal foundation: The deviated portion of the septum is corrected first, since it functions as the structural base that the rest of the nose depends on for alignment.
- Cartilage repositioning and grafting as needed: Depending on the anatomy, cartilage may be repositioned, reinforced, or grafted to stabilize the new foundation and prevent the deviation from returning.
- Facial asymmetry correction: depending on the type of facial asymmetry, supporting maneuvers are performed to straighten the underlying facial platform, stabilizing the nasal deviation repair.
- Cosmetic refinement above the foundation: With a straight, stable base in place, Dr. Westreich refines the visible bridge and tip to achieve facial balance and symmetry.
- Closure: The incisions are closed using Dr. Westreich's preferred closed rhinoplasty technique in most cases, which typically leaves no visible external scarring.
Surgery generally takes place at New Face NY's surgical center under local or general anesthesia, depending on the complexity of the individual case.
Recovery After Foundation Rhinoplasty™
Recovery from Foundation Rhinoplasty™ mirrors the timeline of a standard rhinoplasty, since the external healing process is largely the same regardless of how the internal correction was made. Patients wear a nasal splint for about one week and typically plan to take one to two weeks off work or school.
Swelling reduces gradually over the following months, with the final cosmetic result becoming fully visible within about a year as the tissues settle. Dr. Westreich uses Exparel during surgery, which can provide pain relief for up to three days and reduce reliance on narcotic medication in the early recovery window.
Patients can find a complete breakdown of what to expect day by day, along with aftercare tips, on the practice's rhinoplasty recovery and post-op guidance.
Considering Foundation Rhinoplasty™ with Dr. Westreich
Dr. Richard Westreich developed Foundation Rhinoplasty™ after years of published research into the biomechanics of nasal deviation, and he continues to perform the technique at his private Manhattan practice. Patients weighing septoplasty against a combined functional and cosmetic correction can schedule a consultation to discuss which approach fits their anatomy and goals.
Sources
- Ammar SM, Westreich RW, Lawson W. Fan septoplasty for correction of the internally and externally deviated nose. Archives of Facial Plastic Surgery. 2006. PubMed
- Rhinoplasty. StatPearls, National Library of Medicine. NCBI Bookshelf
