My nostril closes when I inhale normally. Anything I can do?

Dear rosiecon12 in Beverly Hills, California:

     Some people have very weak cartilages in the tip of the nose in the area just above, so it may be just the cartilages there are “moving in” when you inhale deeply.  This is not a very common problem to have on both sides, unless you have had prior surgery.  Certainly, the nasal sprays are not the answer because they only shrink the lining of the nose and have no influence on the architecture.  When you say that you “really wish I could breathe freely through both,” this means that you need a consultation.  My outline for a good consultation was rendered in another answer to a prior question by you but let me reiterate them here.



You want to do your homework before consultation.  Prepare well for your consultation.  When you search, look for rhinoplasty super-specialists.  These are surgeons whose practice is the majority or entirely devoted to rhinoplasty, septoplasty, and related procedures.  This would include both primary and revision rhinoplasty surgery.  Why not have the most specialized talent in your service?  Consider how much experience the surgeon has doing the procedure you are considering. We all get better at what we do with time and so those surgeons who have a long run of experience are the ones who have learned the most from experience. Residency and fellowship are where the learning begins, but for all of us, time and experience is where the education continues.



Part of your preparation for consultation should be preparing a list of questions beforehand.  Bring a notepad or ipad or laptop with you and take notes as the surgeon answers the question you are asking.  You should spend more time with the surgeon than with the office administrative staff, because you need to get a sense of whether you are comfortable with the doctor.  You should not feel rushed that you are on a consultation conveyer belt.  If the presentation by the office staff seems a bit to “salesie” that is a bit of a yellow or red light.  Take a friend or relative along since two heads are better than one in gaining information and understanding.  In the end, the purpose of the consultation is for you to be educated and be comfortable, not to be “ sold”.  Ask yourself two key questions: “Is this surgeon teaching me or selling?” And secondly, “Can I put my life and my face into this particular surgeon’s hands? Can I trust him/her?”



There are excellent books out there that you can read and use to study up. It is worth the homework time you put in up front so that you make the right decision with respect to choosing a surgeon who has the talent, experience, and degree of super-specialization that you certainly want to have. 



When you visit doctor’s websites, the most important feature on the site is the before and after gallery.  If there are just a few examples of rhinoplasty or revision rhinoplasty, you wonder how much experience the surgeon has performing such surgeries.  There need to be dozens and dozens of examples.  The more examples there are, the more likely you will see one or more that demonstrate situations similar to yours.  Look closely at the photos for natural results.  That is what you want.  Nobody wants to carry a sign saying “I have had a rhinoplasty.”



     Reviews on review sites, particularly RealSelf are very important and should be carefully digested. The larger the number of reviews the most accurate the picture of the practice and particularly the doctor. A consensus is generally correct.



     A consultation without computer imaging is, in my opinion, of much less value.  Why shouldn’t you see the predicted result of the procedure the doctor is proposing?  At consultation, photos are taken of you and loaded into a computer system that morphs your present appearance into the anticipated “after” based on the nasal surgeons input.  Imaging is an incomparable learning tool because it provides a forum for doctor and patient agreement on what would satisfy the patient and what is, in the doctor’s opinion, achievable.  After all, cosmetic surgery is 100% visual.  It is about appearance, so without a visual evidence of what is planned, how can you make a decision as to whether or not you might be satisfied.  Talking about it is worthless.  To anticipate a successful outcome, there must be a meeting of the minds between surgeon and patient.



     Best wishes,





Robert Kotler, MD, FACS



Over 4,500 nasal procedures performed

Your problem is way too common!  I've seen so many patients who have true structural problems with their nose being treated with topical medicines. This won't work. Obviously, a thorough history and exam is required but more likely than not you have a narrow internal nasal valve and/or a weak external nasal valve. Combined with any curvature in the nasal septum, you are a set up for nasal obstruction. The solution is generally surgery where the goal would be to strengthen and open the nasal airway using cartilage grafts akin to supporting a sagging tent with stronger poles. Find a rhinoplasty surgeon that you trust to start the process. Good luck!

Dear Rosie,Thank you for your question. While I cannot tell the exact cause of your  problem without photographs, the usual cause is weakness in the cartilage of the nose that collapses upon inhalation. The most common solution for this is a surgical procedure where cartilage grafts from other parts of your nose or your ear are inserted to strengthen the weak cartilage. A well-trained rhinoplasty specialist can definitely diagnose and treat your problem.Good Luck!Shady Hayek, MD

Plastic and Reconstructive Surgery