Is this a collapsed valve after Rhinoplasty? Advice? (photos)

Question

I had an open rhinoplasty in 2014. My breathing was not great before hand and my surgeon used spreader grafts to help support the walls. I had a dorsal Hump reduction along with septum work and an Osteotomy. My breathing as slowly deteriorated and it's really bothering me on a daily basis. It goes through phases and is worse after certain foods/exercise to the point I am trying to hold my nostril open for some relief. I've been to some new doctors since. I would appreciate any advice.

David C. Pearson, MD · Answer

From the photos it looks like there is some alar collapse. This can often be reduced with revision surgery and can include placing alar batten grafts and possibly rim grafts as well. The fact that there's some variation with certain foods also suggests that the turbinates may be too large or too reactive (these are folds of tissue in the nose that congest or decongest). Make sure to see someone who understands nasal function as well as nasal anatomy such as an ear, NOSE, and throat surgeon as well as a facial plastic surgeon or plastic surgeon.All the best,
--DCP
Pearson Facial Plastic Surgery®

Eric M. Joseph, MD · Answer

Based on your photos, one nostril seems to collapse with deep nasal breathing. Depending on your condition and examination, you may benefit from a cartilage graft to support your nasal tip. The feasibility of this would require an examination. Hope this helps. Dr Joseph

Lucian Ion, FRCS · Answer

Hello and thank you for your question. Alar collapse on forced inspiration is present in many people that never had surgery. In most instances, if the tip is wide,  there is compensation for the fact that the sidewall moves in and the airway is protected. When the tip becomes narrower, this airway advantage is lost, and the closure is more significant. Unfortunately, spreader grafts do not assist with this problem , but alar batten grafts can help.  The comment regarding certain foods suggests that there is some obstruction related to the lower turbinated which may become more swollen, and the close partially the internal valve, and then you are trying to take deeper breath which makes the external valve collapse. A similar event may take place with exercise. An examination with a rhinoplasty surgeon can help to untangle these aspects and offer you options for improvement.

John L. Burns Jr., MD · Answer

Spreader grafts are used to open the internal nasal valve and can be assessed with a caudal test.  Your photos suggest that you do have compromise of the external nasal valve which is a separate issue and could be fixed by supporting the nasal ala so that it would not collapse on deep forced nasal inspiration.

Christian L. Stallworth, MD · Answer

Bobby90- Thanks for your question and photos.  Based on the pictures you do appear to have collapse fo the external valve of your nose.  This can be the result of your anatomy, age, previous surgery or previous trauma (or a combination of factors).  Fortunately it can be remedied with revision surgery.  Find a board certified facial plastic surgeon for consultation.

Is this a collapsed valve after Rhinoplasty? Advice? (photos)

Answers (7)

Answer: Secondary rhinoplasty

Answer: Secondary rhinoplasty

Answer: External valve collapse

Answer: External valve collapse

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Everything you need to know about Revision Rhinoplasty

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Is this a collapsed valve after Rhinoplasty? Advice? (photos)

Answers (7)

Answer: Secondary rhinoplasty

Answer: Secondary rhinoplasty

Answer: External valve collapse

Answer: External valve collapse

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.