Upon deep inhalation the side of my nose goes down and becomes less wide, is this normal?

Question

I'm wondering if my nose's cartilage is too weak to support proper breathing. I had a rhinoplasty a year and a half ago and I'm worried it has made my cartilage weaker and less able to withstand deep breathing. Please consult.

George Volpe, MD · Answer

One of the more common reasons for obstruction in the nasal passages when taking a deep breath through the nose is collapse of the sidewall of the mid part of the nose. This can occur when the sidewall cartilage is weakened or if your nose developed in a way where the air passes, it passes through it a very narrow channel. Common techniques to improve this include spreader grafts and side wall batten grafts made out of cartilage. I tend to prefer spreader grafts. If one has had a previous rhinoplasty, a good exam by your surgeon may be able to tell you why you may have obstruction if it exists.

Richard H. Tholen, MD, FACS · Answer

Rhinoplasty changes the appearance of the nose by rasping and repositioning ("breaking") nasal bones, and by trimming, suturing, grafting (layers of cartilage), and bending (changing shape) of cartilages. Typically, the nostril rim support via the alar cartilages is maintained by NOT removing too much of the lateral crura (the "wings") of the lower (alar) cartilages. If too much is removed, then there may indeed by insufficient nostril rim support. Collapse of the rim on hard inspiration can be a result of over-resection.When little or no alar cartilage removal is done, and even with scoring of the cartilage to change shape, scar tissue actually reinforces the cartilage strength. so weakening is truly unusual--improved strength (stiffness) is the more common occurrence. Only with too much removal is rim support lost, and this is more common with re-do rhinoplasty.Your breathing issues may have little or nothing to do with your rhinoplasty, and more to do with septal position, turbinate hypertrophy, or other concerns unrelated to your cosmetic changes. Of course, it's natural to associate perceived breathing differences with your rhinoplasty changes, but only ENT or plastic surgical consultation will be able to assess your concern and present anatomy. Best wishes! Dr. Tholen

Paul M. Steinwald, MD · Answer

Hello Jerry and thank you for your question.  I agree with my colleague and friend Dr. Gutowski below.  It otherwise could be natural "internal valve" collapse (which may have been pre-existing, and may necessitate an internal/higher up "z-plasty" and/or cartilage grafting if severe), but if open tip work/cartilage resection was performed, there may have been some destabilization of that nasal rim (which also likely would be remedied with cartilage grafting)  If not clearly impairing your nasal function, however, this would likely not be worth pursuing, and only should be undertaken by a board-certified plastic surgeon with a significant experience with such problems.

Karol A. Gutowski, MD, FACS · Answer

This depends on which part of the nose gets narrow and if it does impair your breathing. Even someone with a normal nose and no past surgery may see some cartilage movement with deep inspiration. See your surgeon for an evaluation.

Upon deep inhalation the side of my nose goes down and becomes less wide, is this normal?

Answers (4)

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