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

Question

I'm 14 months post op with thin skin and my insides still look like this and i can barely breathe while bicyling or exercising. What is going on?

Thomas Spalla, MD · Answer

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.

Christian Conderman, MD · Answer

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.

Lexie Wang, MD · Answer

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.

Oakley Smith, MD, FRCSC · Answer

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.

Eric M. Joseph, MD · Answer

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

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

Answers (7)

Answer: Rhinoplasty

Answer: Rhinoplasty

Answer: Based on your photos, you may have narrowing of your external nasal valves.

Answer: Based on your photos, you may have narrowing of your external nasal valves.

Recommended reading

Everything you need to know about Rhinoplasty

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

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

Answers (7)

Answer: Rhinoplasty

Answer: Rhinoplasty

Answer: Based on your photos, you may have narrowing of your external nasal valves.

Answer: Based on your photos, you may have narrowing of your external nasal valves.

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

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