Obstructed/Uneven airflow through nostrils (Photo)

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