I Have a Narrow Middle Third of Nose, and Pinched Look. How Come I Can Breathe Only out of the Side That is Narrower? (photo)

I have had two previous rhinoplasties. I am generally happy with the look, however I have breathing problems out my left-hand side. Incidentally, the left hand side is less pinched and has a fuller middle third. The right hand side is narrower and more pinched, yet I can breathe better out of it. The specialist I saw recommended spreader grafts, warning that the middle third may look wider, but does this make sense given the fact I can breathe out of the side which looks more collapsed?

Doctor Answers 7

Breathing Problems after 2 Rhinoplasties

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It sounds like you have more than one cause for your breathing problems. A narrow mid vault can compromise the nasal airway, but you need an examination to determine if other corrections are necessary.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Breathing issues

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There are many variables that go into breathing. AIr flow is dependent on many things including external and internal valve issues, septal deviations, turbinate hypertrophy, and allergic rhinitis to name a few.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Looks can be deceiving concerning breathing after rhinoplasty

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Sometimes the cause of the reduced airflow just is not apparent when we look at the outside of the nose. The balance in airflow can be related to the septum and turbinates as well and how they interplay with the nasal valve (pinched area). Only a careful exam will determine if the spreader graft alone will provide a fix.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Post rhinoplasty breathing difficulty

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From base view, it looks as though you have external valve compromise secondary a small mass at the superior aspect of left lower lateral cartilage which may be granuloma or cystic lesion. Your surgeon should be able to remove it.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

Pinched Look after rhinoplasty!

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From your photos it appears that you have severe external valve collapse on both sides as well.

Spreader grafts will not fix your problem, you will need batten grafts or lateral crural strut grafts.

I would consult with an experienced rhinoplasty specialist.



Michel Siegel, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 113 reviews

Breathing problems after rhinoplasty

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I agree with Dr. Yoo that there are multiple factors that can affect your nasal airflow.  It looks like on your base view that you may have "recurvature" of the left lower lateral cartilage.  This is yet another factor that might explain why you have more trouble breathing on the left.  The lateral part of the cartilage that makes up and extends out from the tip curves into the nose.  This is also why you have the little depressions on each side just above your nostril rim where the nose attaches to the face. I think you should get a second opinion by an ENT/facial plastic surgeon. 

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Causes of nasal obstruction in rhinoplasty.

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Besides the internal nasal valve (middle third) there are a number of other factors that could be causing your breathing to be worse on the left, including but not limited to: septal deviation, turbinate hypertrophy, external nasal valve collapse, et cetera.  The best way to make a determination which areas would need to be addressed is by physical exam.  The "specialist" is the only one that assessed your dynamic breathing, so it's possible you have left-sided middle third collapse on deep inspiration that's not present on a static image.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 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.