Barely an airway after rhinoplasty. What is going on? (Photo)

Hi!
It looks like you have recurvature of the lower lateral cartilages which are causing narrowing of the nasal valve area (the narrowest portion of the internal nasal airway). Oftentimes, tip suturing maneuvers are done at the time of nasal surgery that do produce a narrower tip externally, but by bringing the tip (lower lateral cartilages) closer to the inside of the nose, this can also have an impact on your ability to breathe through your nose. I have seen similar cases in my practice and oftentimes I will adress the configuration of the cartilage with a graft placed on the undersurface of the cartilage (lateral crural strut graft) to help open up the nasal passageway. Hope that helps.

Hi, it looks to me like your surgeon was over-aggressive in trying to make your tip smaller and has now given you a pinched nose appearance with lateral crural collapse, which is why you don't see an airway when looking up in that view in the first picture. This is unfortunately something that will need to be fixed with another surgery.

Hi ,It is better for you to consult with a facial plastic surgeon who can examine you and discuss the surgical procedure and the post op recovery
process.

On front view, you appear to have some pinching of your nasal tip on both sides, and on your base view, you can see that the cartilage inside of your nostril is practically touching your nasal septum. This can be a cause of nasal obstruction after rhinoplasty surgery. Short of surgery, you can consider using breathe right nasal strips that are an external spring to keep your nasal valves open. Repair of this condition typically requires lateral crural strut grafts. In that regard, consider Consulting with several reputable rhinoplasty specialists so you can see what might be best for you moving forward. I hope this helps. Sincerely, Dr Joseph

Hello, hope you are well. Thank you for submitting your question and photos. Unfortunately, rhinoplasty surgery can result in weakening of the nasal valves such that they become collapsible which makes it difficult to breathe (especially with strenuous activities). One of the visible external signs of this is when the tip of the nose appears pinched in from the sides. If that is the case (you need a real physical exam to be certain), the problem requires revision rhinoplasty to be corrected.
Best,Dr. Tower

Unfortunately, based on the imaging, it is not surprising you can't breathe after your rhinoplasty.
From the basal view, you have narrow external nasal valves. Given the lack of scarring here, this is probably your baseline.
The front view is much more problematic. Your tip appears to have been aggressively reduced which has led to internal nasal valve collapse. Complicating this, your middle third appears to have been reduced. I suspect hump removal was performed without stabilizing the upper lateral cartilages - thus leading to further internal nasal valve collapse and an inverted-V deformity. This has also left you with deviation of the nose.

It also appears that high osteotomies were done to close the open roof deformity from surgery and this placement is also impinging on your airway.

In short, there is no medical solution for your issue as it's structural in nature. You will require the expertise of an experienced revision rhinoplasty surgeon. I suspect that additional cartilage will be required - ear, rib, or cadaver - to remedy this situation.

The information you provided is insufficient to make an assessment.
Rhinoplasty is not an operation. It is a general term for reshaping the nose. There are many different operations included under the umbrella called rhinoplasty.
For example, rhinoplasty surgery may include in fracturing to narrow the nose.
Before undergoing rhinoplasty surgery, patient should have a thorough examination, including an intranasal exam to check airway passages.
Individuals who have passages may not be good candidate for in fracturing during rhinoplasty. These individuals may need a complementary. Septoplasty or turbinate reduction in order to maintain open airways after the procedure. Sometimes spreader graft need to be placed.
Rhinoplasty surgery is Fadley complex and patient should be careful and choosing providers who have extensive experience with his procedure.
For individuals who need secondary or revision surgery you need to ask yourself if your selection process was adequate for the first provider?
In choosing your surgeon how many consultations did you go through before selecting that provider? How many rhinoplasty surgeries has that surgeon done in their career? How many before and after pictures did they show user in the consultation?
Considering that revision rhinoplasty is many times more difficult and complex than primary procedures. Patients should be careful when making decisions regarding who is the best provider to do a secondary rhinoplasty.
Having multiple operations makes everything more difficult and more complex lowering the chance of an overall quality outcome.
Are being board-certified in plastic surgery with years of experience does not mean somebody has mastered every single procedure, especially not complex operations like rhinoplasty surgery.
You should definitely follow up with your provider and have him or her address your concerns and hear what they have to say.
It may be wise to have multiple in person second opinion, consultations with local plastic surgeons who have extensive rhinoplasty experience or preferably focus exclusively on rhinoplasty surgery before having a second procedure.
Best,
Mats Hagstrom, MD