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Shifting Nasal Obstruction Post Rhinoplasty

I have difficulty breathing post rhinoplasty. There's scar tissue in my nasal passages+ edges of the upper laterals have pierced the skin (can be seen)+ there's a slight open roof def. My doctor says it's not a valve collapse but inverted V, yet it's barely visible. He wants to use grafts to widen that area. The blockage shifts rather quickly from nostril to another depending on the position of my head, and it's severity changes. I also feel an ache and pressure. Is grafting the only way?

Doctor Answers (15)

Best Treatment for Shifting Nasal Obstruction Post Rhinoplasty...Somnoplasty

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Hi Fergi,

Love your work with the Black Eyed Peas!

If your breathing is shifting dependant on head position, then your inferior nasal turbinates are a large factor in your nasal obstruction.  I would recommend radiofrequency volumetric tissue reduction of your inferior nasal turbinates with a treatment called Somnoplasty by Gyrus.  The treatment is in the office with topical and local anesthesia, takes a few minutes, and is rather painless.  There is no nasal packing, surgery, or grafts involved.  At worst you will breathe better, and most likely you may be able to avoid going back to the operating room.  If the "inverted V deformity" is barely visible, I would stay away from surgeons who want to operate for at least 12 months after you have your inferior turbinates treated with Somnoplasty.

Good luck and be well, regards to Will I Am.

Dr. P

Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Breathing problems after rhinoplasty

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If the pattern of obstruction switches from side to side, it is possible that your turbinates are enlarged. Turbinates are internal nasal tissue which consists of both bone and mucosa.  I often reduce them as part of a rhinoplasty to avoid airway problems.  If you are having a revision anyway, it is worth considering turbinate reduction.  It's quite simple to perform at the same time as rhinoplasty.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 13 reviews

Nasal Airway Obstruction Post Rhinoplasty

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It is not uncommon to have early post operative nasal congestion after a rhinoplasty. It usually resolves in 6-8 weeks. One can use nasal spray frequently. If it persists more than 6 months, one may have a functional internal nasal valve scarring that needs to be corrected by an experienced rhinoplasty surgeon.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 20 reviews

The use of spreader grafts in rhinoplasty

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It is very difficult to answer your concerns accurately without an examination. However, in my opinion, spreader grafts are the best solution for mid-vault collapse (inverted V and internal valve narrowing as you have alluded to).

Other causes of difficulty breathing may be smoking (if you smoke, you may NEVER have your subjective feelings of obstruction resolved), inferior turbinate hypertrophy, and, the one most surgeons miss, excess or deviated vomer bone (the vomer sits behind the septum, so even if the septum is straightened, the crooked vomer can cause airway obstruction).

I hope this information is helpful.

Best of Luck.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon
4.5 out of 5 stars 11 reviews

Post rhinoplasty shifting blockage

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You mentioned a number of technical terms ,inverted V deformity, nasal valve collapsee, opem roof , upper lateral infringement, etc. Without detailed photos or hands on examination it is diffivult to give an intelligent opinion. Shifting nasal obstruction may simply be due to inferior turbiante swelling when dependent, but you should be seen by an experienced revision rhinopalsty surgeon. Good luck

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Nasal Congestion after Rhinoplasty Surgery

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Hi Fergi999,

Nasal congestion is common immediately after rhinoplasty surgery, which is commonly due to internal swelling, crusting, or mucous. Chronic nasal congestion after rhinoplasty may be due multiple factors such as scarring, cartilage collapse, deviated septum, or swollen turbinates. Nasal congestion that alternates between sides suggest that enlarged turbinates may play a role in your symptoms. In addition, an "inverted V" deformity suggests possible cartilage collapse which may be treated cartilage grafts. Only after a comprehensive evaluation by a rhinoplasty specialist can he/she help determine appropriate options for you. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 53 reviews

Nasal airway obstruction treated with spreader grafts

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I do like spreader grafts for both the inverted V-deformity and for widening of the internal valve so that your breathing is improved.  However, you may not need surgery if it is more airway complaints.  It could be the turbinates that need shrinking or that the mucosa is reactive and you need an inhaled nasal steroid.  I would see a revision rhinoplasty specialist in your area to be sure.

Jay Calvert, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 25 reviews

Nasal Obstruction Post Rhinoplasty

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There is compromise of the internal valve with an inverted V defromity, which will cause nasal obstruction -  spreader grafts are usually the most reliable treatment. You need to be evaluated by an experiewnced nasal   surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Nasal Obstruction After Rhinoplasty

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Inverted V deformity is the sign of collapse of the upper lateral cartilages causing nasal obstruction. This can be corrected by variety of techniques including spreader graft which is insertion of a small piece of cartilage between the upper lateral cartilage and dorsal septum for support and widening of internal nasal angle leading to better airways. Your obstruction may be complicated with existing deviated septum as well as intranasal scars or enlarged turbinates. Your surgeon should be able to differentiate these for you.

Mohsen Tavoussi, MD, DO
Huntington Beach Facial Plastic Surgeon
4.0 out of 5 stars 6 reviews

Inverted v deformity

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An inverted "V" deformity is often due to midvault collapse. This is best treated with spreader grafts wit wident he  middle vault and improve the airway.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.