I have undergone 3 major rhiniplasty surgeries and countless in office procedures to correct nostril collapse and nasal valve collapse after my primary rhinoplasty. I had alar batten grafts and spreader grafts placed 2 weeks ago. My breathing was initially wonderful right after surgery and for the week following, but now it is going downhill again. Is there anything that can be done at this point? In addition, I have terrible scars. Has anyone else had this issue and can this be fixed?
Is There Any Way to Fix Nostril Assymetry and Collapse? (photo)
Doctor Answers 5
Nasal Valve Collapse
It can be very tricky to treat nasal valve collapse. I would agree that you need stiffer support to keep the nasal valve open. This may be performed with stronger cartilage or a thin "tip-top" medpor graft. If you consider revision surgery, make sure you choose a surgeon with plenty of experience with this issue.
Hard to correct valve collapse in a scarred nose but there is hope
In terms of your scarring, I would wait a full 6 months to really examine this. Two weeks is just too early to start making judgements about this. It looks like you have had Weir (nostril narrowing) procedures in the past which contribute to the nostril deformity (and breathing trouble) as well. The collapse may be due to old scar tissue. The type of grafting material is important as well as Dr. Kim has pointed out. In revision rhinoplasty, stiff cartilage, usually costal (rib), is necessary to help withstand the forces of scar retraction and the subsequent nasal collapse. Visits to your surgeon will help with your concerns. Good luck to you!
Most likely stronger, stiffer grafts are needed to improve your nasal valve problems
The more severe the nasal valve problem, the stronger, stiffer, and larger the supporting graft needs to be to remedy the problem. It seems like you have a difficult problem and it may be that the grafts currently in place are not sufficient to overcome your collapse. Sometimes for complicated nasal valve problems, particularly in multiple revision cases, I will utilize cartilage grafts constructed from rib cartilage to provide enough support. As for your scars, scar revision may helpful, but this will require additional excision of skin which can slightly further narrow your nostrils. The link below provides some information about my approach to nasal valve problems.
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Uneven nostrils and scars after Rhinoplasty
Nostril asymmetry may improve as swelling resolves after any rhinoplasty, however repeated surgeries may lead to asymmetry that is difficult to correct. Scars can often be improved with well-timed skin resurfacing performed at six weeks post-op or later in the healing process.
Is There Any Way to Fix Nostril Asymmetry and Collapse?
You will need to heal for a few months before contemplating another revision. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.
Kenneth Hughes, MD Los Angeles, CA