Do I Need Revision Rhinoplasty to Improve Breathing?

I had a Rhinoplasty done to correct a slightly deviated septum and improve breathing due to the nose collapsing inward. Spreader grafts were placed near the tip of the nose to correct this problem.

It has been 18 months since the procedure and the air flow in one nostril is very restricted due to enlarged turbinates. Also, the tip of the nose feels very hard and unnatural.

Can a revision rhinoplasty trim the interior to clear the air flow? Should the spreader grafts be removed? It doesn't seem as if they are doing much to help the breathing anyway.

Doctor Answers 13

Difficulty breathing through the nose after surgery

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There are several possible explanations for your difficulty breathing following nasal surgery. These include a residual deviation of your septum, hypertrophy of your turbinates,  scar bands within the nose, narrowing of the internal or external valves, and medical causes of nasal congestion, such as allergies. Examination of the inside of your nose by a nasal specialist should reveal the etiology. If it is the size of your turbinates, these can be shrunk by using nasal steroid sprays (Nasonex, Flonase, Rhinocort, etc.) or by performing a turbinate reduction procedure. If the spreader grafts are sitting in the proper position, they should help your breathing not hurt it. 

Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Revision rhinoplasty for nasal breathing issues

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Revision rhinoplasty may be indicated if you have significant breathing issues. The airflow of the nose can be affected by the bony and cartilaginous framework of the nose being in abnormal position. Cartilage grafting or other procedures can be used to augment the nose so that breathing is improved. These include batten grafts for external collapse or spreader grafts for midvault narrowing. Newer techniques include bone-anchored sutures (may be a better alternative in some cases).

In addition, any 'swelling' inside the nose may be caused by allergies or other nasal sensitivities and may not be corrected with surgery. This is best treated medically and may be a lifelong issue.

Hope this helps,

Dr. Sam Most

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 69 reviews

Revision Rhinoplasty: Correcting Breathing Problems after Rhinoplasty

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There are several reasons why patients continue to have breathing problems after rhinoplasty. These fall into two major categories: (1) Structural, and (2) Physiological. Structural problems of the nasal framework include: residual deviation of the septum, internal valve collapse from inward collapse of the bridge, external valve collapse from poor support to the nostril sidewalls, and blockage from scar tissue. Physiologic or functional breathing problems are often related to swelling of the turbinates and inflammation of the nasal lining from allergies.

Seek the advice of a revision rhinoplasty specialist who can address both the function and structural aspects of your breathing problems.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

Improving breathing with Revision Rhinoplasty

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Revision Rhinoplasty may be indicated to fix your breathing difficulties. It is hard to determine what your exact problems are without physical examination. You may have several structural issues that could be causing the difficulties in breathing. These may include the thinning of the nose, turbinate hypertrophy, or residual deviation of the septum. I would go in and discuss these concerns with your surgeon. If the spreader grafts are properly placed there is no reason for removal. Possibly partial turbinectomy would resolve your breathing problems. Wishing you the best!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

No definitive answer to your question without examination

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There are many causes of nasal airway obstruction after rhinoplasty.

These include: enlarged turbinates, persistence of a deviated septum, internal valve collapse, external valve collapse, allergies, atrophic rhinitis, midvault collapse, and on and on.  It is hard to say if you need revision surgery.  A complete exam with an intranasal exam, and a complete history is necessary before a decision on revision surgery can be made.

Raghu Athre, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 94 reviews

Many possible causes of restricted nasal airflow

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There are any possible causes of restricted airflow in your nose. Certainly, structural issues such as an enlarged turbinate, persistent deviated septum, and external valve/persistent internal valve narrowing are possibilities. Non-structural issues such as allergic or non-allergic rhinitis could also play a role, however. A thorough exam by a experienced nasal surgeon would be the best way to determine the exact cause in your case.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Proper breathing and nasal surgery

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The most important thing before undergoing any revision nasal surgery is to determine the residual cause of your airway obstruction.  Just because you have had spreader grafts they might not have opened up your internal valves, what about your external valves.  The turbinate might or might not significantly impinge on your airway.

This is a rather complex problem, and you should not have to decide yourself what's the proper course of action.  Make sure you consult a well qualified nasal surgeon to properly evaluate your nose.  Revision rhinoplasty requires a surgeon with experience and expertise to undertake this rather difficult procedure.  Make sure that the next rhinoplasty you have is the last one.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
4.8 out of 5 stars 62 reviews

Improving Nasal Breathing with Revision Nasal Surgery

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Nasal breathing may be improved with revision nasal surgery. However, nasal blockage can be due to many factors including a deviated septum, enlarged turbinates, nasal allergies, sinus polyps, structual narrow nasal valve, or chronic sinus problems to name a few. Routine cosmetic rhinoplasty may not necessarily address internal nasal or sinus conditions which contribute to nasal blockage.

Revision surgery to improve a deviated septum with septoplasty or turbinate reduction may be necessary. The septum may shift or deviate again, and turbinates may swell up and enlarge again. Prior to jumping to revision rhinoplasty, a trial of nasal allergy medication may be appropriate.

Only after a comprehensive evaluation can a rhinoplasty specialist advise you on appropriate options.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Difficulty breathing after rhinoplasty can ber corrected

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However the cause can be due to several reasons. In these situations you need the advice of an expert rhinoplasty surgeon. The most critical and revealing part is the examination of the nose. Often the nose will need to be decongested to determine what role the turbinates are contributing. Other times the outer wall of the nose can be lifted outwards to show what role this part of the nasal valve is playing. A residual deviation of the septum can usually be confirmed by careful examination of the inside of the nose. Once the cause of the difficulty breathing is determined then a surgical plan can be formulated to correct it.

Revision rhinoplasty improve breathing

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After rhinoplasty, a small percentage of patients may experience some tightness or difficulty with breathing through the nose. If this is the case, you should seek a consultation by a board-certified plastic surgeon who will be able to examine the outside and inside of your nose and determine the cause. One common cause may be the collapse or tightening of the intranasal valve. If this is the case, you may be well served by receiving a revision rhinoplasty that can help open this valve using small pieces of cartilage. This can be a tricky procedure. For best results be sure that you're only working with a board-certified plastic surgeon who has a great deal of experience in rhinoplasty, revision rhinoplasty, and cartilage grafts.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.