What Can Be Done if my Nose Seems Too Narrow and I Have Trouble Breathing Thru It?

Many patients with very thin noses and weak structural nasal support have trouble breathing through the nose due to nasal valve collapse. Repair of nasal valve stenosis or nasal valve collapse is a technically challenging procedure and should be customized to the individual patient. A thorough history and physical exam would be needed to determine the proper diagnosis and treatment, but if the septum is straight, the turbinates are small, other causes of nasal obstruction are ruled out, and the nasal valve area is clearly incompetent on exam, then surgical repair of the nasal valve area is likely warranted.
This is something that I commonly see and correct in my practice. This is also something that is not commonly performed by ENT surgeons or by plastic surgeons who perform very few rhinoplasty procedures.
Be sure to see an expert such as a facial plastic surgeon to review all the options.
Best,

Thank you for this inquiry and I am sorry to hear you are dealing with this problem. The nasal septum and turbinates are common causes of nasal obstruction, but there are also other causes which must be considered. If the cartilages are weak or flimsy, as you would imagine, the force of inspiration (breathing in) will easily collapse them leading to airflow blockage. This can happen congenitally or can be a result of reducing the size or integrity of the cartilages with surgery. This problem can be corrected with rhinoplasty using grafts to stabilize the nasal sidewalls and prevent collapse. This would also allow for straightening the septum if it is deviated somewhere that may not have been initially visualized that may also be contributing. There is a relatively new device(small absorbable implant)  called Latera, that can be used as an alternative or adjunct to grafting that may also help with this problem.
In any case, a consultation with a rhinoplasty expert such as a facial plastic surgeon or plastic surgeon will allow for thorough assessment and discussion of corrective options. 

Difficulty breathing most commonly occurs form one of the followings:1.  Enlarged turbinates -- sausage like structures that humidify the air that can enlarge from allergies.2.  Narrowed Internal or external valves,  structures in your nose can collapse when breathing in reducing air flow.  Correction requires cartilage grafts to help open the nose at the areas of collapse.3.  Deviated Septum4.  PolypsAn examination and/or CT scan can help with the diagnosis.  Best of Luck, An in-person exam with a
board-certified plastic surgeon is the best way to assess your needs and
provide true medical advice. Best of
luck. Dr. Michael Omidi

Dear Mrs Stuffy

Breathing through your nose may feel stuffy at different times of the day.  From your description, you may have collapse of the sides of your nose (but usually Breath rite would help this).  You may have other airway obstruction sites that could be identified by a nasal endoscopic examination.  If you havent' had a scope placed in your nose, then schedule another consult for an airway examination.  

It may be that fixing your narrow nose can make it look better, but not help you breath.  This is good to discover before surgery so that you are not disappointed.  Best Wishes.

Consider a consultation with an ENT or plastic surgeon. A simple examination will disclose whether you have a collapsed nasal valve or other internal nasal problem which would restrict airflow.  There could also be a deep septal deviation which isn't readily visible so a second opinion could not hurt and may provide you with some guidance and suggestions for treatment.

It is impossible to say what can be done to improve airflow through your nose without a face to face physical examination. If as you say the septum and turbinates are not the reason for the decreased airflow and in the absence of prior surgery or trauma the most likely cause is collapse of the nasal valves when breathing. The treatment then would depend on which valve is involved.

You can test this for youself closing off/collapsing one nostril with your index finger. Lift your chin up and look in the mirror as you inhale and exhale through the nose. If you see the open side collapsing during the breathing the cycle that is a problem with a nasal valve. The treatment is placement of cartilage grafts inside the nose to prevent the collapse. The position of the graft will depend on which valve is involved.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Narrowness to the mid part of the nose will often cause some difficuties with breathing.  The normal nostril flairing that opens up the nostrils to bring more air into the nose may actually collapse or pull inward with inspiration.  This could compound your problem, but even without narrowing to the tip of the nose there may be internal narrowing.  This area is called the internal valve, and certainly can cause decreased air intake with  inhalation.  The correction for this is to have cartilage grafts placed into "created pockets" internally that will widen the distance between the upper lateral cartilages.  This will create a wider distance between the internal valve structures, all of which allows more air to come into the nose with inhalation.  Many qualified Plastic Surgeons can perform this type of surgery.  The grafts are called "spreader grafts".

 

Contact a Plastic Surgeon that you feel comfortable with and ask about your desire for this type of surgery'

 

Good luck.  Frank Rieger M.D.  Plastic Surgeon  Tampa