I have had two previous rhinoplasties. I am generally happy with the look, however I have breathing problems out my left-hand side. Incidentally, the left hand side is less pinched and has a fuller middle third. The right hand side is narrower and more pinched, yet I can breathe better out of it. The specialist I saw recommended spreader grafts, warning that the middle third may look wider, but does this make sense given the fact I can breathe out of the side which looks more collapsed?
I Have a Narrow Middle Third of Nose, and Pinched Look. How Come I Can Breathe Only out of the Side That is Narrower? (photo)
Doctor Answers (7)
Breathing Problems after 2 Rhinoplasties
It sounds like you have more than one cause for your breathing problems. A narrow mid vault can compromise the nasal airway, but you need an examination to determine if other corrections are necessary.
There are many variables that go into breathing. AIr flow is dependent on many things including external and internal valve issues, septal deviations, turbinate hypertrophy, and allergic rhinitis to name a few.
Looks can be deceiving concerning breathing after rhinoplasty
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Post rhinoplasty breathing difficulty
From base view, it looks as though you have external valve compromise secondary a small mass at the superior aspect of left lower lateral cartilage which may be granuloma or cystic lesion. Your surgeon should be able to remove it.
Pinched Look after rhinoplasty!
From your photos it appears that you have severe external valve collapse on both sides as well.
Spreader grafts will not fix your problem, you will need batten grafts or lateral crural strut grafts.
I would consult with an experienced rhinoplasty specialist.
Breathing problems after rhinoplasty
I agree with Dr. Yoo that there are multiple factors that can affect your nasal airflow. It looks like on your base view that you may have "recurvature" of the left lower lateral cartilage. This is yet another factor that might explain why you have more trouble breathing on the left. The lateral part of the cartilage that makes up and extends out from the tip curves into the nose. This is also why you have the little depressions on each side just above your nostril rim where the nose attaches to the face. I think you should get a second opinion by an ENT/facial plastic surgeon.
Causes of nasal obstruction in rhinoplasty.
Besides the internal nasal valve (middle third) there are a number of other factors that could be causing your breathing to be worse on the left, including but not limited to: septal deviation, turbinate hypertrophy, external nasal valve collapse, et cetera. The best way to make a determination which areas would need to be addressed is by physical exam. The "specialist" is the only one that assessed your dynamic breathing, so it's possible you have left-sided middle third collapse on deep inspiration that's not present on a static image.