Nasal valve collapse on the right side of my nose? I can only breathe properly when I gently pull my cheeks. (Photo)

Question

I had a rhinoplasty 9 days ago ; my surgeon removed a hump, changed the droopy tip and used cartilage grafts to strengthen my nostrils. The problem is I still can't breathe properly through my right nostril. Yet I don't have any scabs or anything and when I take a deep breath, my nostril doesn't move. At first, I thought my breathing difficulties were due to swelling but now I'm starting to think I may have internal nasal valve collapse : when I gently pull my cheeks, I can breathe perfectly.

James Bonaparte, MD, MSc, FRCSC · Answer

I am really impressed,  you basically learned what most med students learn about nasal valve collapse all by yourself! When you pull on your cheeks, you are doing the "cottle maneuver" which basically opens the valve. Let me start by saying, nasal valve collapse is a very difficult problem and one that can be fixed if you have the proper assessment. It all comes down to physics. Some people think that if you put those struts in your nostrils it will not collapse, but that is not correct.  Sometimes the collapse is actually due to the septum and oddly, it can happen on the side of your nose that is actually wider and more open! This has to do with a physical principle of airflow mechanics. If one side is narrow and you breath in, the increase airflow on the opposite side causes "negative pressure" or a suction resulting in your valve collapsing. To fix  this, there are a few options. One, is to make sure your septum is straight. that would be my #1 question. If it is, the next step would be to tighten your nasal valves. There are some new, highly effective techniques for this. Hope this is helpfull.

Vincent N. Zubowicz, MD · Answer

It's still too early to make this diagnosis but it's possible that the internal nasal valve has been damage. Correction will require placement of a spreader grafts.

Vartan Mardirossian, MD · Answer

Let me just tell you that anyone who pulls their cheek sideways will achieve better breathing from that side. I bet that if you pulled your cheek on the other side your breathing would improve as well so the "Cottle maneuvre" is anot a very good indicator. It is totally possible that you have an internal valve collapse though. This can only be seen on an endonasal exam though. It can be fixed and this is a routine procedure. This can happen with some approacheds for rhinoplasty but also if the cartilage has been overresected. You need an expert to evaluate you as revision rhinoplasty is not done by all.

Jaimie DeRosa, MD · Answer

Dear Marzipan,I would recommend talking with your plastic surgeon about your concerns.  It is not unusual for nasal breathing to be diminished weeks after rhinoplasty, and he or she may be able to suggest treatment now that could help improve your right nasal breathing.Best of luck,Dr. DeRosa

Nasal valve collapse on the right side of my nose? I can only breathe properly when I gently pull my cheeks. (Photo)

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