With two rhinoplasties and nasal valve collapse what is the possibility of the surgery being successful? (photo)

Question

I had a rhinoplasty 6 years ago because I thought my nose was big especially from the bottom. After my first surgery and after seeing the results the doctor said he needs to do another one for some minor changes.My breathing was perfect but after the rhinoplasty I got what seems to be nasal valve collapse and I can't breathe while sleeping without stretching the skin on my cheek. I am tired of this and I also don't like how it looks like.i know I have thick skin.Should I go for another surgery?

Brock Ridenour, MD · Answer

I'm sorry to hear that you are having a difficult time right now.  In my 20+ years experience with revision rhinoplasty, I have seen two main reasons for impaired breathing following nasal surgery.  If the bridge of the nose has been lowered excessively, the middle portion (middle vault) of the nose can collapse inward. This can restrict breathing is known as internal nasal valve collapse. Alternatively, if the  tip cartilages have been operated, they may have be weakened by excision, bending, or scar tissue. Weak tip cartilages cannot resist the forces of inspiration and the sides of the nose (nostrils) can collapse with deep inspiration. This is known as external nasal valve collapse. Sometimes, both internal and external factors exist at the same time.Because you still have good skin quality you are candidate for surgery.  The surgeon will need to use cartilage from your septum or rib to build a framework that provides both aesthetic form and function. Find a surgeon experienced in revision rhinoplasty that can tackle your breathing and cosmetic problems simultaneously. Good luck

George Bitar, MD · Answer

Surgery to correct nasal valve collapse wiith cartilage grafting can be quite successful in improving breathing. It will not change the appearance significantly but it will improve the function of your nose. Best wishes.

Thomas A. Mustoe, MD, FACS · Answer

Although you have had two previous surgeries, your skin quality looks good, and there is no reason you could not undergo additional surgery. Your nasal tip is over projecting ( sticks out a long ways from your face), and it looks as although your upper dorsum was lowered but not the nasal tip, which I can understand is not the look you want.  The nasal valve collapse can be improved in a straightforward fashion, but having had previous surgeries, you made need to get cartilage from elsewhere. The ear cartilage is too soft, and so if indeed there is not available cartilage in the septum, then you would need to harvest some cartilage from your rib.   At this time, a minor revision is not going to get you what you want. I would choose a surgeon experienced in revision rhinoplasty.

David Reinstadler, MD · Answer

I am sorry you are having breathing difficulties after your surgery. It is unfortunately not uncommon for patients to experience nasal valve collapse after a rhinoplasty. Most commonly, the bridge of the nose is lowered and this includes lowering the upper lateral cartilages along with the septum and nasal bones. If the upper lateral cartilages fall down slightly, the will block airflow through the internal nasal valve which is already the most narrow portion of the nose. The fact that pulling the skin of your cheek or using breathe right strips helps, indicates that small grafts placed along the septum will likely improve your breathing significantly. This is done with surgery, but it sounds like you are not totally happy with the cosmetic outcome either. I would suggest having a consultation with a revision rhinoplasty surgeon so they can discuss what is possible in your specific instance.Best of luck

With two rhinoplasties and nasal valve collapse what is the possibility of the surgery being successful? (photo)

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