Breathing and Tip Problems After Rhinoplasty

Agatha:
You are only a month out and this is too early too draw any final conclusions.
Scarring can take six weeks to develop and another 6 weeks to settle down.
We generally don't take our postoperative photos of noses until 6 months and many recommend a year in order to assess the final results of surgery.
Also breathing can be affected by the swelling which occurs during this period as well. This may have been aggravated by the hematoma but gives this time to resolve.
I know it is difficult to e patient but it is better that you wait at least 3 months and preferably 6 months before you draw any conclusions.
Generallly, we don't worry as much about dependence upon saline nasal spray as we do about addiction/dependence on nasal decongestants especially Afrin type products which can cause rebound swelling
You may want to ask your physician about steroid nasal sprays to decrease intranasal swelling/scarring. Some physicians also use steroid injections to decrease or soften scarring. Physicians vary on their opinions about this and you can experience other unwanted side effects.
The fact that you can breathe better with saline spray is a good sign. If it were a rigid scar, it is less likely that it would improve with saline spray. You may find that breathing in water vapor through a vaporizer or in a steam shower will also provide you with improvement.

It’s not unusual for patients undergoing rhinoplasty to have prolonged swelling.  This swelling can adversely impact the aesthetic result and cause difficulty breathing through the nose.  Several factors including the use of open rhinoplasty, fracture of the nasal bones, thickness of the nasal skin and previous rhinoplasty have been associated with prolonged swelling.
            Most patients will note significant swelling for about two weeks following surgery.  After two weeks, most patients are comfortable resuming their normal lives and going out in public.  Swelling will persist in most patients for at least one year following surgery, with the nasal tip being the last site to experience resolution.

            In the immediate postoperative period nasal splints, elevation of the head and ice can be used to minimize swelling.  In some cases, crusting and scabbing within the nasal passages may also contribute to breathing problems.  Under these circumstances, nasal saline and hydrogen peroxide irrigations may be helpful as well.

            The postoperative period is characterized by rapid change.  For this reason, both functional and aesthetic improvements can be anticipated.  It’s therefore important to be patient and maintain good communication with your plastic surgeon. 

Thanks for your question and follow-up comments.
It is good to see you're getting some improvement in inhalation at three months. As you can see time can be an important factor with rhinoplasty.
Has the tip deviation improved?
The problem with inhalation can come from residual internal swelling. You may want to ask your surgeon (if you don't know) if he did any work with your turbinates or if on re-examination he discovered the turbinates to be prominent.
Another important test to perform to assess inspiration difficulty is a test called the cottle test.
You can perform this yourself. Place your index finger at the side of the of your nose on your cheek just above your nostril. Gently pull laterally and see if your breathing improves. If it does you may have "internal valve collapse" which likely was not caused by the surgery but always existed. There are surgical techniques to fix this.
I hope this helps.