All cases require prior approval. Consideration will not be given to cosmetic rhinoplasty.

Rhinoplasty may be considered medically necessary only in limited circumstances and where the clinical rationale fits with the evidence base as follows:

1. When it is being performed to correct a nasal deformity secondary to congenital cleft lip and/or palate;
2. Upon individual case review, to correct chronic non-septal nasal airway obstruction from vestibular stenosis (collapsed internal valves) due to trauma, disease, or congenital defect, when all of the following criteria are met:
   • Airway obstruction which will not respond to septoplasty and turbinectomy alone
     AND
   • Nasal airway obstruction is causing significant symptoms (e.g. chronic rhinosinusitis, difficulty breathing)
     AND
   • Obstructive symptoms persist despite conservative management for three months or greater, which includes, where appropriate, nasal steroids or immunotherapy
     AND
   • Photos demonstrate an external nasal deformity
     AND
   • There is an average 50% or greater obstruction of nostrils (e.g. 50% obstruction of both nostrils; or 75% one nostril and 25% of other; or 100% obstruction of one nostril), documented by endoscopy, CT scan or other appropriate imaging modality

There are, however, exclusions  that need to be addressed such as:

• Unstable mental health
• Unrealistic patient expectations
• Previous rhinoplasty within the last 9-12 months (applies only to major rhinoplasties)
• Poor perioperative risk profile
• History of too many previous rhinoplasties, resulting in an atrophic skin–soft tissue envelope and significant scarring
• Nasal cocaine users

To submit an application to the CCG's Individual Funding Request Panel, please click here for further information.

Please click here to view the full Rhinoplasty & Septorhinoplasty Commissioning Statement. 

Policy date: September 2016

Next Review date: September 2018

©NHS Vale of York Clinical Commissioning Group

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