Does a Pinched Valve/narrow Mid Vault and Bulbous Tip Obstruct Airflow, and Can This Be Fixed by a Septoplasty? (photo)

A deviated septum can block your breathing. So can large turbinates and/or a narrow external nose called the nasal valve. It's not always easy to determine what is the specific cause. If there is any doubt, I suggest a second opinion from a nose specialist. If your nasal valve needs to be strengthened it should be done at the same time as a septoplasty since the best graft material we use to strengthen your nasal valve is from the nasal septum. A photo doesn't always show the answer. A personal exam is very important for such subtle findings.

If one has a pinched mid-vault from previous nasal surgery this does cause internal nasal valve collapse and can be corrected with an open approach and use of spreader grafts from the septum. This can significantly improve breathing.

We can discuss the causes of anatomic airway obstruction at length. But ONLY intra nasal IN PERSON examination allows definitive diagnosis. Best to see a boarded surgeon in your city. BTW bulbous tip does not add to air way obstruction. 

There are multiple issues that can cause nasal obstruction  from the internal portion of the nose, and these include a deviated nasal septum, unilateral or bilateral valve collapse, turbinate hypertrophy  and a nasal fracture.  A bulbous tip does not  impair breathing and is only reduced for cosmetic purposes.  When an hourglass nose is present, many times there is a valve collapse issue and spreader grafts are required to open up the nasal valve. Spreader grafts are usually composed of the patient's own cartilage harvested from inside the nose. Virtual rhinoplasty software is available on our website for you to try.

A pinched nasal valve does typically contribute to nasal obstruction while a bulbous nasal tip is strictly a cosmetic issue. A septoplasty alone will change neither the tip nor the nasal valve region. If you do have a deviated septum it will likely improve your breathing but will not improve the nasal valve region. Cartilage grafts are typically required in that area to add structure and prevent collapse. This can be performed with a septoplasty and is usually referred to as a septorhinoplasty procedure. I hope this information is helpful.Stephen Weber MD, FACS
Lone Tree Facial Plastic Surgeon

Good question.  Here is the deal:

Obstruction to airflow can come from multiple locations inside and outside the nose.  The septum is only one of the areas and it may be only part of the problem.  A pinched middle vault can cause breathing problems as well as cosmetic problems.  A bulbous tip will not cause breathing problems and its a cosmetic issue but supporting the tip can improve breathing.  Ultimately it sounds like you have not found the right surgeon for your situation.  Look for a great Facial Plastic Surgeon or Plastic Surgeon who specializes in noses.  This is an intricate anatomic and physiologic structure and getting it right the first time gives you the best chance at success.  You want a pretty nose and one that helps you breath. 

Your nose appears to be narrow in the middle third of its vertical height. This corresponds to the "internal nasal valve" area. A good intranasal exam may confirm this as a point of obstruction for you. There are other structural reasons for impaired breathing including enlarged nasal turbinates, a curved septum, or weak side (lateral) parts of your lower lateral cartilages, which make up your nasal tip, that collapse when you breath in. These problems are usually covered by health insurance. The round tip does not cause obstruction by itself and is an aesthetic concern that be addressed with some refining techniques.

A pinched valve or more specifically what we call internal nasal valve collapse can negatively the nasal airway.  However, typically a bulbous tip does not.  Surgery for internal nasal valve collapse usually involves placement of spreader grafts which are cartilage grafts placed on along the nasal dorsum in the mid portion of the nose.  This improves the airway but also improves the "dorsal aesthetic lines" of the nose.  A septoplasty corrects a deviated septum and does not specifically address nassal valve collapse. One way to test for nasal collapse is try a breath right strip and see if that dramatically improves nasal airflow.  Also lateral soft tissue traction on the cheek pulling the nose out can also be done to test for nasal valve collapse. 

A pinched nasal valve does reduce nasal airflow. A bulbous tip should not alter nasal flow.

Many thanks for very interesting question with simulated images. I am not aware if the tip of the nose is connection to internal valve correction or Septoplasty. An ENT surgeon is not conducting an Aesthetic tip plasty for you and therefore what ever you have seen on YouTube does not belong to your problem. I am sure Septoplasty will not change of your tip of nose and will have to do anything any thing will your internal valve. Wish you good luck.