Post Rhino Breathing issues / collapse (Photo)

Question

1.5 years post rhinoplasty Overall results are okay, but I cannot breathe out of the right nostril still. A small amount of air can make its way in and out. I also have unevenness from below and I am wondering if the right side has slight collapse. I was advised to continue nasal spray but that hasn’t resolved the issue. If I pull the cheek slightly or push the lower nostril slightly outward, I can breathe.

Gianfranco Frojo, MD · Answer

The maneuver you are doing is called the Cottle maneuver. It opens the internal nasal valve passageway, which is composed of the upper lateral cartilage, septum, and inferior turbinate. Any disharmony between these structures may cause internal nasal valve narrowing and therefore airway obstruction due to decreased air flow. I would recommend getting a second opinion and an intranasal examination with a reputable American Board of Plastic Surgery certified surgeon.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question
As far as I can understand from your question
You should have a detailed examination, the inside of the nose needs to be checked and a path can be followed accordingly.
Best Regards!

Andrew Miller, MD · Answer

On your photos, the right side does appear to be going inward a bit. This would have to be evaluated with a full set of photos and exam, but it the nasal valve is narrowed, this can be improved with a revision rhinoplasty. Cartilage grafting can be placed properly to accomplish the result while keeping the nose looking good. Be sure to see a rhinoplasty expert for consultation.

Eric M. Joseph, MD · Answer

When somebody's breathing is significantly improved by pulling the cheek away from the nasal septum, that tends to mean that there is a narrowing of the external nasal valve. Generally, something like that may be repaired with a lateral crural strut graft to support the airway. Since that would necessitate revision rhinoplasty, and since the slight asymmetry at the base view of your nose is not perceptible to most, if you could live with this, that would be the best. If you can't, consider meeting with several reputable rhinoplasty specialist so you can see what to expect moving forward.

Thomas Spalla, MD · Answer

Your symptoms are highly suggestive of nasal valve collapse. I would suspect the internal nasal valve given where you are pulling on your cheek for results and the fact that your nostril itself does not appear to be collapsed.

Internal nasal valve weakness/collapse is very common after reduction rhinoplasty if maneuvers aren't performed to decrease that possibility.

A revision may be warranted given the failure to improve with medical intervention.

Post Rhino Breathing issues / collapse (Photo)

Answers (6)