Breathing after Rhinoplasty

After rhinoplasty, changes in the dynamics of air flow through the nose are very common.  A successful rhinoplasty should leave the nose looking balanced, and breathing better.

Complications responsible for breathing problems after rhinoplasty are as follows:

1. Nasal valve collapse - a narrowing of the cartilage-containing portion of the bridge. This complication can have both functional and cosmetic consequences.  The area where the side cartilages (upper lateral) meet with the septum along the midline of the lower portion of the bridge may cause a narrowing that is worse on deep inspiration.  This can be corrected with spreader grafts, but is best avoided with spreader grafts, or a flap of the upper lateral cartilages (ask your doctor to explain this during the consultation if he/she beleives it may be necessary).
2. Deviation or re-deviation - a very common cause for nasal obstruction is deviated nasal septum.  The septum (wall in between the two sides of the nose) is commonly noted to be deviated in many people.  This deviation may not be symptomatic, but in the setting of an altered nasal airway after reduction or occasionally over-reduction of the bridge, the deviation may cause nasal obstruction on one or both sides.  Moderate or severe deviations should be addressed during surgery to help avoid breathing problems.
3. Inferior turbinates - these are normal tissues responsible for congestion of the nose during colds, allergies, weather changes, or even crying.  The inferior turbinates should be somehow addressed during almost all rhinoplasties.  Current standard of care for the inferior turbinates involves conservative reduction methods that preserve the mucus membrane, but shrink the overall size of the turbinates to releive any nasal obstruction that may be symptomatic after surgery.  Some patients with breathing problems after rhinoplasty may benefit from an office procedure to shrink the mucus membrane of the inferior turbinates to improve the nasal airway.  As a component of the nasal valve (see above) turbinate reduction may also releive some symptoms associated with the narrowing of the valve area.  This procedure is an integral part of almost all of my rhinoplasties.
4. Internal nasal scarring (synechiae)- some operations result in inadvertant (in some cases possibly careless) abrasions or scratches of the mucus membrane inside of the nose.  The septum (middle wall) and the outer walls may have opposing scratches that heal together, and effectively close or narrow the nasal cavity.  Correction involves releasing or removing the scars, and placing splints inside the nose for one to two weeks to prevent recurrence.
5. Over-resection - aggressive removal of cartilage and bone can lead to weakening of any part of the nose.  The external valve (nostril openings) may also be weakened by aggressive reduction of the skeletal components of the nose and also collapse or close during inspiriation - especially during exertion.
6. Perforation of the nasal septum - a dreaded complication of surgery, a perforation of hole in the septum of the nose may cause nasal obstruction by altering the dynamics of airflow through the nose, crusting, scarring, even frequent bleeding and blood clots.  Experienced surgeons have fewer reported complications such as this, and should also be well versed in techniques to prevent, and repair perforation of the nasal septum. 

These are topics which you should feel comfortable discussing with your surgeon.  An experienced rhinoplasty surgeon may even discuss these with you during your consultation, and should always ask directed questions regarding your nasal health and breathing.  A thourough examination of the nasal cavity should also be preformed during a consultation to plan for prevantative measures during your rhinoplasty surgery.

Dr. T

8 of 9 found this helpful

Helpful?

Contact the doctor

The short answer is no.

The typical rhinoplasty done in the 1980’s or even 1990’s relied heavily on reduction of prominent cartilage and bone to achieve a more refined look. Knowledge of the long-term effects of such techniques was spotty and, so, many unfortunate patients were left with the trademark ‘operated’ appearance of a pinched, droopy, or distorted tip, and scooped-out nasal bridge. These occurred because the newly-weakened structural elements of the nose could no longer provide the necessary support, often leading to breathing trouble.

The forces of healing are dynamic and often operate for several years before these outcomes are evident. So, a postoperative result may look great immediately after surgery, yet evolve into a dismal failure over time. Likewise, collapse of the nose’s structural supports will compromise the basic function of the nose, namely breathing.

Modern thoughts on rhinoplasty take a much more conservationist approach. As much as possible, reshaping and contouring are achieved with suture and graft techniques that will usually leave the nose ‘stronger’ than it was preoperatively.

While many surgeons think of nasal breathing more as an afterthought, those who have an interest and experience in rhinoplasty will assign as much importance to nasal function as to aesthetics. The result, at Profiles Beverly Hills, is that once short-term swelling is resolved, your breathing should be as good or better than before and the changes to your nose should remain ‘stable’ for a lifetime.