Do I Need Revision Rhinoplasty to Improve Breathing?

There are several possible explanations for your difficulty breathing following nasal surgery. These include a residual deviation of your septum, hypertrophy of your turbinates,  scar bands within the nose, narrowing of the internal or external valves, and medical causes of nasal congestion, such as allergies. Examination of the inside of your nose by a nasal specialist should reveal the etiology. If it is the size of your turbinates, these can be shrunk by using nasal steroid... more

Revision rhinoplasty may be indicated if you have significant breathing issues. The airflow of the nose can be affected by the bony and cartilaginous framework of the nose being in abnormal position. Cartilage grafting or other procedures can be used to augment the nose so that breathing is improved. These include batten grafts for external collapse or spreader grafts for midvault narrowing. Newer techniques include bone-anchored sutures (may be a better alternative in some cases). In... more

There are several reasons why patients continue to have breathing problems after rhinoplasty. These fall into two major categories: (1) Structural, and (2) Physiological. Structural problems of the nasal framework include: residual deviation of the septum, internal valve collapse from inward collapse of the bridge, external valve collapse from poor support to the nostril sidewalls, and blockage from scar tissue. Physiologic or functional breathing problems are often related to swelling of... more

Revision Rhinoplasty may be indicated to fix your breathing difficulties. It is hard to determine what your exact problems are without physical examination. You may have several structural issues that could be causing the difficulties in breathing. These may include the thinning of the nose, turbinate hypertrophy, or residual deviation of the septum. I would go in and discuss these concerns with your surgeon. If the spreader grafts are properly placed there is no reason for removal. Possibly... more

There are many causes of nasal airway obstruction after rhinoplasty. These include: enlarged turbinates, persistence of a deviated septum, internal valve collapse, external valve collapse, allergies, atrophic rhinitis, midvault collapse, and on and on.  It is hard to say if you need revision surgery.  A complete exam with an intranasal exam, and a complete history is necessary before a decision on revision surgery can be made.

There are any possible causes of restricted airflow in your nose. Certainly, structural issues such as an enlarged turbinate, persistent deviated septum, and external valve/persistent internal valve narrowing are possibilities. Non-structural issues such as allergic or non-allergic rhinitis could also play a role, however. A thorough exam by a experienced nasal surgeon would be the best way to determine the exact cause in your case.

The most important thing before undergoing any revision nasal surgery is to determine the residual cause of your airway obstruction.  Just because you have had spreader grafts they might not have opened up your internal valves, what about your external valves.  The turbinate might or might not significantly impinge on your airway. This is a rather complex problem, and you should not have to decide yourself what's the proper course of action.  Make sure you consult... more

Nasal breathing may be improved with revision nasal surgery. However, nasal blockage can be due to many factors including a deviated septum, enlarged turbinates, nasal allergies, sinus polyps, structual narrow nasal valve, or chronic sinus problems to name a few. Routine cosmetic rhinoplasty may not necessarily address internal nasal or sinus conditions which contribute to nasal blockage. Revision surgery to improve a deviated septum with septoplasty or turbinate reduction may be... more

However the cause can be due to several reasons. In these situations you need the advice of an expert rhinoplasty surgeon. The most critical and revealing part is the examination of the nose. Often the nose will need to be decongested to determine what role the turbinates are contributing. Other times the outer wall of the nose can be lifted outwards to show what role this part of the nasal valve is playing. A residual deviation of the septum can usually be confirmed by careful... more

After rhinoplasty, a small percentage of patients may experience some tightness or difficulty with breathing through the nose. If this is the case, you should seek a consultation by a board-certified plastic surgeon who will be able to examine the outside and inside of your nose and determine the cause. One common cause may be the collapse or tightening of the intranasal valve. If this is the case, you may be well served by receiving a revision rhinoplasty that can help open this valve... more

If the breathing is worse thatn before you may need revision surgery to better support the collapsing areas of the nose (I prefer alar batten grafts over spreader grafts for this type of problem in most cases). If the new obstruction is caused by an enlarged turbinate, either medication to shrink the turbinate (like nasal steroid sprays which are used to treat allergic problems of the nose) or turbinate reduction surgery may be helpful.

The questions you ask are impossible to answer without a good physical examination. If the turbinates are causing obstruction, they can be modified. As you state, the spreader grafts are used to open a narrow air passage; if they are in proper position, removing them probably will not be beneficial. A revision sounds appropriate.

The turbiantes will need to be fixed to be able to breath better. Spreader grafts maintain the inner nasal valve open and helps a lot with breathing. The outer nasal valve is a different anatomy and should be addressed.