Is this nasal valve collapse or can UCL strut be placed unilaterally? (Photo)

Hi Jim85,
From the picture you provided, it does seem like a nasal valve collapse is a possibility. However, 5 months is not a very long time for rhinoplasty recovery. It takes at least 12 months for the initial swelling to recede, and some patients can experience asymmetries during this time.
Your surgeon seems to be taking the right steps to address the problem without recurring to surgery. In order to see the final results and decide whether you want to have a revision rhinoplasty performed, you need to wait more time and work with your physician to improve the symptoms meanwhile.
Best of luck
Dr. Sam Rizk

Hello, and thank you for your question. Since you are only 5 months post-op it is currently too early to tell what the final results will be. It can take up to a year, or longer, for the final results to show especially for individuals with thicker skin. If you are concerned, I would recommend that you see your surgeon to discuss what's going on.

Hello,Thank you for your pictures and the question. The asymmetry and swelling are clearly visible in the photo.  But its not enough time  to evaluate the final result.  There may be several reasons for shortness of breath.  İt can be like soft tissue edema, scar tissue, or septum deviation.  Be sure to adhere to the advice of your surgeon.  Before making a decision, get a different opinion.  I wish you good luck and be patient.
Best Regards, 
DR CEM PAYASLI 
MEMBER OF INTERNATIONAL SOCIETY OF AESTHETIC PLASTIC SURGEONS

Dear Jim85,Thank you for your question. It is hard to give you a defintive answer based off that one photo and the information you have provided. A strut graft is not normally used for primary rhinoplasties. There is probably a discrepancy in the symmetry of your LLCs. In any case, you will need to wait a year for any tip swelling to fully resolve before considering a secondary surgery.Good luck,Nirmal R. Nathan, M.D.

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgeons
Fellowship-trained Craniofacial Surgeon
RealSelf Top Doctor and RealSelf Hall of Fame

There is an asymmetry in the domal and lower lateral cartilages that is causing the alar hang on one side and not the other.  Whether this is causing the obstruction would need to be diagnosed by seeing how the nose changes with inspiration.  If there is collapse of the bridge cartilage vs the tip cartilage vs some septal deviation.  A revision to correct this asymmetry would be recommended.  

Thank you for your post.  This is an important question to answer, and I am glad so many surgeons are giving their opinion on this one.  Remember that swelling in the nasal tip is not 100% resolved until about a year after rhinoplasty.  This can obviously affect airflow as well, as the swelling is on the inside too.  Even if you do nothing, your airflow and appearance of the tip are likely to improve significantly as swelling continues to decrease.  I don't see anything on your photo to get excited about at this point.  Try to be patient, and make sure you go to all of your followup appointments.  Try to avoid any revisions until all the swelling is gone.  Reoperating on a small problem can often turn it into a bigger problem.  Best of luck to you!

Post-operative nasal airway obstruction can be organic (i.e. anatomic) but can also be due to swelling/edema.  I often will recommend that patients try using Flonase or some other nasal steroid spray after surgery when this occurs. Often times, it will result in some improvement. If the problem is still there one year after surgery, then I may consider going back to taking a look. Of course, an in person evaluation is always important in making these types of decisions.

It is very difficult to make a diagnosis of your issue with the photo provided and limited history of the procedure. Take time ti discuss your concerns with your surgeon. Remember that is rhinoplasty final results take time and major revisions should be delayed until healing is complete. You can always obtain a second consult  if you are unable to get an answer.

Hmmm in reality this is a pretty tough question without an in person exam.   I also think getting your operative report to determine whether spreader grafts were placed at all...  I do like small dose steroids for tip thickening from fibrosis but I'm not sure that is your issue.  Internally you do need an exam or a CT to help determine what to do.  Best Wishes!!

Postoperatively, after a rhinoplasty, you can anticipate bruising and swelling that is noticeable to others for 1-2 weeks. Sutures are removed at 1 week along with any internal or external splints. You will notice that your own nose is swollen for another 2-3 months. Final healing time can take up to 1 year.
Based on a single photo it is impossible to comment on functional status, such as state of the internal valve. Trust your surgeon and give yourself time to heal.