After rhinoplasty is it common to have breathing problems?

The goal of rhinoplasty surgery should be first to maintain function and second to achieve improved aesthetics. While there are complications of surgery which can produce difficulty breathing, such as a perforated septum or nasal collapse, in general, a well trained and experienced rhinoplasty surgeon should be able to achieve a good cosmetic result in a functioning nose. The presurgical assessment is important to determine if you have any breathing difficulties which may be worsened after surgery. In addition, the surgeon may not be able to achieve all of the cosmetic goals that you want because of functional concerns. Again, speaking with a qualified surgeon is always critical to achieving the best result.

The goal of rhinoplasty is to improve the aesthetic appearance but also to maintain function.  However, sometimes during the early post-operative period some patients complain of difficulty with breathing.  This is usually due to swelling which improves in the first few weeks after surgery.

Due to the considerable amount of swelling after rhinoplasty, patients experience restriction of airflow through the nose in varying degrees.  The restriction on airflow from a rhinoplasty subsides within the first couple of weeks after the surgery.    Complete obstruction out of the nose is common if a septoplasty is performed or any turbinate surgery is performed at the same time as a rhinoplasty.  Once the swelling from a rhinoplasty and/or a septoplasty has resolved there should be no breathing issues whatsoever in the postoperative phase. 

Hopefully, if you have problems breathing through your nose before rhinoplasty, the problem will be fixed after surgery. Problems with breathing through your nose can be from the inside anatomy being less than ideal. This can happen if you've had trauma to your nose in the past , from nasal medications, allergies, sinus problems, or just developmentally. When evaluated before surgery, these problems can many times be corrected during the rhinoplasty surgery. Often we may need to straighten the septum that leans too much to one side or reduce turbinates which take up too much space.

If you don't have problems with breathing before surgery, sometimes problems can occur if your nose isn't supported correctly after the reshaping has been completed. Improper support is the most common cause and can result in your nose collapsing when you breathe in. This can certainly be a nuisance afterwards if it isn't recognized and corrected during the procedure. Most experienced rhinoplasty surgeons are aware of this and take the proper steps to prevent it. Otherwise, realize the swelling on the inside of your nose after surgery will limit airflow and create stuffiness for 2-3 weeks until it normalizes.

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

A well-trained rhinoplasty surgeon should always examine the nose functionally to make sure that any cosmetic adjustments do not interfere with breathing.

When I evaluate a patient's nose, I look at the septum and turbinates internally. I check to see how long the nasal bones are. I evaluate the openings to the nose to see that they are well-supported on inspiration. Any areas of collapse are noted and corrections made during surgery.

I always try to leave the nose better that I found it. Make sure your surgeon does the same. Good luck!

Although always a concern , this does not seem to be a common problem. I performed hundreds of rhinoplasties, and most of them are designed to reduce size of the nose. Patients are usually not bothered by the change of the nasal airway.

However, if one has breathing problems before nasal surgery, the nasal airway has to be evaluated and septoplasty/turbinate surgery maybe indicated. This is usually combined with  cosmetic surgery of the nose. This portion (functional) of this procedure may be covered by insurance . 

Immediately after rhinoplasty, packing (in some cases), swelling, and mucous/bloody fluid will definitely make you feel like there is a clothespin on your nose. After a week or two, as the swelling resolves, the great majority of patients can breathe as well or even better than they did before the surgery.

Many surgeons ignore the nasal septum when performing cosmetic rhinoplasty. When the nose is reduced, it is essential that the septum is also reduced. If not, a previously straight and non-problematic nasal septum will buckle and deviate, causing breathing problems. If the nasal septum is deviated to begin with, then it must be corrected. The only time that the septum can be left alone is if the nose is not to be reduced, and if it is relatively straight to begin with.

Another cause of post-op breathing problems is when too much lower lateral nasal cartilage is removed in the attempt to reshape the tip of the nose. Lastly, the lateral internal walls of the nose have structures called inferior turbinates. They can be reduced permanently in a non-invasive in-office 15 minute procedure called Somnoplasty.

Please remember to choose your rhinoplastic surgeon most carefully to avoid these and other problems.

Be well and good luck.
Michael A. Persky, MD, FACS

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.