Obstructed/Uneven airflow through nostrils (Photo)

Hello and thank you for your question and the pictures. Unfortunately, breathing issues are quite common after rhinoplasty if the initial surgery did not properly reinforce the underlying structural framework (bone and cartilage). It sounds like you now have collapse of your Internal Nasal Valve on the right side. An open revision rhinoplasty can best address this functional issues and any potential aesthetic concerns with your nose. I would be able to open up and reinforce your internal and external nasal valves to improve the airflow through your nose!

This truly a surgery of millimeters- and revision rhinoplasty is actually the most technically challenging surgery in all of plastic surgery- it requires exceptional surgical skill to achieve functional and natural-looking results! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in revision rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading revision rhinoplasty experts (who performs 1,000+ nosejobs annually).

I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with revision rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Turbinates are organs in the nose that filter and humidify the air, and these can change in size. When somebody has an upper respiratory infection and can't breathe through their nose, it is because the turbinates get very big. When you lie on your Left side, gravity will cause your right turbinate to decrease in size from Gravity. Simplest thing to do would be to try a topical antihistamine nasal spray like Astepro in your nose on your right side a half hour before bed. If this is not helpful, please consider Consulting with your surgeon or an otolaryngologist. Thank you for your question. Sincerely, Dr Joseph

It appears that you have external valve collapse due to inadequate support of the nostril openings. This can be fixed with cartilage grafts to bolster the valve open. A true physical exam is needed to be able to determine what is going on.

yes, you clearly have collapse of the right nasal valve as based on your photos and your symptoms. ..

Your description points to a couple of possible causes of nasal obstruction that would require an in-person evaluation with a specialist to truly assess. Nasal obstruction while lying flat or in a recumbent position can point to inferior turbinate hypertrophy (as all the tissue in the nose, in particular the turbinates, congest in that position). Your description of pulling the cheek outward and having improved breathing is called the Cottle Maneuver. Many surgeons find the Cottle maneuver alone to not be a very specific test as to what the problem is as most people benefit from this. Additionally, the Cottle maneuver represents an unrealistic metric as there isn't a surgical solution that would directly mimic that change. A modified Cottle performed by a trained rhinoplasty specialist could pinpoint causes of your nasal obstruction in what is anatomically referred to as the "valve" areas of the nose.

Hello and thank you for your question. An in-person intranasal examination would be the best way to determine what the potential issue is. The issue is usually a combination of a deviated septum with an internal nasal valve collapse. A good surgeon can likely improve this for you. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Hello, there are many different reasons as to why an airway might be impeded after rhinoplasty. Although the best way to know is to look directly into the nose, here is some information that might help. The septum and the turbinate may be the source of obstruction, however these would not likely get worse after surgery, and would have likely been an issue before surgery. One thing that gets modified with surgery are the supporting cartilages. They give shape to the nose and structural support. The lateral crus of the lower lateral cartilage plays a big role. It can give a fullness appearance to the tip. There are many different ways to address this cartilage including cutting away a portion of it, bending it with sutures, supporting it with other cartilage etc... when it is modified, the nasal side wall may be narrowed, lose support, or the cartilage itself might recurve and obstruct airway. This has to be determined on examination. To explain what you are feeling... when you pull the skin under your eye outward, you are performing a "Cottle maneuver" to pill the nasal side wall and open the airway at the nasal valve. This is how breath right stripes work... these can help at night until the issue is corrected. When you lay on your left side, more blood rushes to the left, away from the right, reducing some congestion and opening the airway. This suggests that maybe you can improve the airflow with just reduction of swelling and not have to address the valve. The first step in most cases is to trail a spray like flonase for at least 4 weeks (I prefer sensimist as it doesn't have a smell or taste, and goes in nicely) ... read the instructions on how to direct the spray, most people do it wrong and spray toward the middle, hitting their septum.The best choice is to see your surgeon for an exam and explain what you feel. Hope this helps, good luck!

Thank you for your question. Breathing changes that occur after rhinoplasty may be due to a variety of causes including blockage on the inside of the nose. It is key to have your rhinoplasty surgeon do an examination of the inside portion of the nose on both sides to determine potential causes..

There’s not a whole lot we can do without in person evaluation, including an intranasal examination.
Follow up with your provider or get a second opinion consultation.
Best,
Matt Hagstrom, MD