Nasal valve collapse following open primary rhinoplasty (Photo)

Question

Hello surgeons, Slightly + 7 months post primary rhinoplasty; breathing has been severely compromised since. My surgeon said it's "a little pinched"; ENTs have said, "nasal valve collapse." I've recently gone on revision consultations; surgeons believe they can make nose less bulbous while opening up airway. Since I've been burned once--emotionally, financially, aesthetically, and medically, I'd love some opinions if you believe this is possible: a FUNCTIONAL thinner, prettier nose. Thank you!

Suleyman Tas, MD, FEBOPRAS · Answer

Hello,Thank you for the question and provided photos, Since you are in your healing phase, you have edema and swelling until you complete your healing which is at least one year long you will have edema&swelling and before completing your healing any intervention should not be performed.Nasal valve collapse occurs when the narrow part of airway weakens due to alterations, it collapses.You need to wait your healing process to be completed.Regards,

Ira D. Papel, MD · Answer

It does sound strange but providing good support for the nasal sidewall can actually make the tip look smoother and smaller. Your right nostril looks to be collapsing which makes the tip look wider and bulky. Using cartilage to restore the normal contour and strength can reduce the shadows and look better as well. Although it is only 7 months this problem most likely will not solve itself and surgery may be your best choice. make sure you work with an experience rhinoplasty surgeon who understands your functional and aesthetic concerns.

Alejandro Nogueira, MD · Answer

Let's comment, firstly, on your preoperative nose; it was featured by two technical challenges not all the surgeons are comfortable or familiar with:-a difficult bulbous, rounded and severely asymmetrical tip; this would have required high end structure rhinoplasty procedures, few different grafting options and a full reshaping of the tip, for sure with tip grafting and massive defatting; eventually with lateral cruras symmetrization by batten or strut grafting, even a full lateral crura replacement so the support tripod to the tip would not be leaning towards one side; needless to say this was not done and instead an aggressive weaking of the lateral cruras has lead to nostril collapse, nasal valve collapse and an unsightly tip-secondly, but the one less surgeons are expert in dealing with, you suffered from a broad humpless dorsum with rectangular shape; there are 3 kinds of broad humpless dorsums: hourglass (broad radix, narrow middle vault and broad supratip), rhomboid (narrow radix, broad middle vault and pinched supratip) and the rectangular, yours, in which the broadness affects all the entire dorsal lenght somehow equally (all radix, middle vault and supratip are broad); the treatment of a broad dorsum with a prominent hum is simple: cut away the hump and the broad dorsum comes with the "lid" or "roof" you remove; but... if the dorsum has no hump or is a minimal hump... then the tempting but disastrous option is lowering it as much as the broadness is gone, this leads to a saddle nose deformity or sunken dorsum and I am afraid is your case, furthermore leaves the dorsum even broader; the treatment of a broad humpless dorsum (of any of its 3 kinds) is a paremedial resection of cartilage and bone without lowering itSee the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.Better images would help to a thorough assessment or might modify my previous opinion, in any case I recommend you seek the advice and hands of a serious professional who offers to you a 
time-consuming and expensive procedure; stay far from minimally 
invassive snake-charming procedures, synthetic implants, fillers, 
wrapped diced cartilage, etc.
Difficulty 6-8 out of 10 in revision rhinoplasties, surgical time about 4-6 hours (in expert hands, could be even longer).
If you wish better grounded opinion well lit, focused and standard 
images have to be assessed: frontal, both lateral and both oblique 
views, from underneath.
Feel free to request any additional information from me.

Mark Ginsburg, DO · Answer

Your photos, you appear to have some alar collapse as well as some deviation.  I would be interested in seeing the operative report from your surgery to see what exactly was done, these issues could be a result of a number of things.  The tip does appear to be somewhat bulbous but it is still early, full swelling may last a year and the tip is usually the last part to go down.  An in person eval would be best but I would say there is hope for some improvement.

Mark B. Constantian, MD, FACS (retired) · Answer

The internal valves (the sidewall in the middle third) depend on the height and integrity of the bridge. When the bridge is reduced even 2 mm, the internal valves become unstable and can collapse and decrease the airway by 50%. I know this by my published 600 patient rhinomanometric study over 16 years.The external valves (the sidewall in the lower third) depend on the position and strength of the tip cartilages. If the lateral crura (the tip cartilages above your nostrils) are reduced, or if they are anatomically malpositioned by the way your nose naturally is, the airway can again go down by another 50%. Thus a rhinoplasty can theoretically reduce your airway by 75%.You clearly have external valvular collapse, but it is likely that your internal valves are collapsed also. This is readily correctable as long as the surgeon is experienced in this kind of work. It can be done without changing your profile or nasal shape at all, unless you wish other changes there as well. The proven techniques are spreader grafts or dorsal grafts for the internal valves and grafts into the alar walls to strengthen the nostrils. Although other methods are advocated, none have outcome evidence in the literature.Your doctors are right, but there is certainly a cure. Good luck to you

Nasal valve collapse following open primary rhinoplasty (Photo)

Answers (5)

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