Can Rhinoplasty Surgery Make my Breathing Worse?

We see many patients who had wanted a more refined nose and ended up with a pinched tip, nasal collapse, and breathing problems. We often enter into a lengthy discussion regarding what would need to be done during a revision surgery to correct both their breathing concerns and improve any aesthetic issues.

Often, these two overwhelming concerns are aligned. That is, whatever must be done to improve your breathing (usually involving grafts) would also tend to make your nose look better. On the other hand, sometimes these concerns may work against each other.

For example, improving breathing might involve having to widen or enlarge your nose slightly at the bridge (with spreader grafts) or the tip (with tip or batten grafts), something we need to take into account when we consider nasal aesthetics. Most people, when we show them how widening their noses slightly would appear on computer imaging, are quite happy with the idea. They feel that the new image looks more natural and returns them closer to the nose they had wanted originally.

But, some patients who had rhinoplasty many years ago or when they were very young may have lived with the look and feel of their current noses for so long that it is all they remember. They may not report more than minor breathing problems even though significant nasal obstruction is evident on examination. Their current level of nasal breathing is all that they know. These patients are often pleasantly surprised after revision rhinoplasty because they never knew they could breathe so well.

Likewise, while most patients are horrified with a pinched and shortened nose, a minority of patients may have learned to incorporate this look into their body images. So, they may not be too interested in the idea of widening or lengthening their noses. This is usually not an issue for men who can tolerate a stronger nose.

Our challenge is to find the happy medium here to create a nose that looks good for you and through which you can breathe. It wouldn’t make any sense to give you a narrowed, ultra-refined nose if you can’t breathe through it.

Similarly, when we must reconstruct and widen your nose to improve its function, we need to thin and tailor our grafts so that they also enhance your nasal aesthetics or, at the very least, have no negative impact. Again, it makes no sense to us to have you breathing perfectly through a big, overbearing nose that dominates your other features.

Finding balance and restoring harmony is the key that, with careful consideration and planning, can be achieved. We look forward to any other questions you may have on this topic.

When it comes to rhinoplasty, form and function go hand in hand. A nose which is straight, well balanced and well-constructed should also function well in terms of breathing. After rhinoplasty, there may be a period of a few weeks or months during which the nose is more congested than baseline but this should be a transient phenomenon. In the long run, rhinoplasty which is performed by an expert surgeon should improve your ability to breathe (if you have any difficulty) or maintain your nasal airway in cosmetic surgeries. 

Form and function must be treated equally.

A cosmetic Rhinoplasty should support or improve breathing.

Complications or poorly performed Rhinoplasty can result in airway problems.

Yes-one of the well-known risks of rhinoplasty is nasal obstruction. As rhinoplasty has evolved over the years, we have come to appreciate the importance of maintenance of nasal structural integrity during rhinoplasty. This has reduced the incidence of nasal obstruction after rhinoplasty. Seek the opinion of someone with an understanding of both nasal function and aesthetics. A good intranasal and external exam, including exam of your septum, turbinates, and nasal valves, will help in this regard.

Hope this helps.

In the past, the aesthetic improvment sometimes took precedent over functionality.  I think in the present day, the majority of surgeons I think are keenly aware of maintaining function while improving the aesthetics.  However, that being said, some patients breathing may be altered.

It is very true that older techniques in rhinoplasty could make patients have breathing problems. Modern structural rhinoplasty is very different. Using surgery methods that are non-destructive we can deliver very good cosmetic changes without sacrificing function. In my practice we often combine functional and cosmetic surgery where we are making patients breath better while improving the appearance of their nose. It is essential that you talk to your surgeon about these concerns and make sure they use modern structural techniques

There is always a risk of compromising breathing when performing rhinoplasty. Although preservation of critical aspects of the anatomy are respected during the rhinoplasty procedure, this is not always possible. From a strictly physical perspective it is harder to breathe through a smaller structure and in most instances, the aesthetic goal is to achieve a smaller nose.

The great majority of air on breathing in flows through the bottom portion of the nose, therefore efforts to narrow the bridge and usually the middle third of the nose have little impact on the breathing. However, overzealous resection of cartilage of that mid-third, and/or narrowing of the nostrils can in fact reduce air movement. This is something you need to discuss with your surgeon, who if he is also an otolaryngologist/ENT, can for sure properly advise you about.

A properly performed rhinoplasty procedure should not adversely affect breathing.  It should improve it if breathing was an issue pre-operatively.  Form and function should go hand in hand -- in the right hands. However, when narrowing the nose by performing osteotomies (cutting the nasal bones) the angle between the septum and lateral cartilages can be reduced and have a negative outcome on breathing.  Other maneuvers can certainly affect breathing as well. Any surgeon who is versatile at performing rhinoplasties knows this.  However, in inexperienced hands, breathing can be compromised when the focus is limited to improving appearance only without consideration of the effects on function.  Choose your surgeon carefully.

It has been proven that a properly preformed rhinoplasty actually improves breathing. However, whenever you have surgery on the nose, there is a chance that breathing may worsen. For this reason, it is important to pick a highly skilled surgeon to maximize your chance of a good outcome.