Scar Tissue / Adhesions Post Rhinoplasty

From your description, the most likely cause of your breathing difficulties is a post-operative adhesion between the septum and the lateral wall of the nose where the turbinates used to be. 

This can often be released and resolved very simply and easily, in the office using either local or topical anesthetic.  Following the release of the adhesion, often a stent will be placed to prevent the adhesion from reforming, during the early  healing period.

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

If you had septal and turbinate work performed during your Rhinoplasty Surgery, you may have formed scar tissue (synechiae) that could be obstructing your breathing. These bands of scar tissue may be divided in the office with topical anesthetic (lidocaine on a piece of cotton), and you should notice improved breathing immediately.

You may want to consult a reputable ENT for a second opinion.

I hope this is helpful for you.

Regards from NJ:

As you recover from rhinoplasty there are a number of conditions that can cause difficulty breathing. The earliest problems come from swelling and debris. Adhesions or bridges called synechea can also form that might be easily treatable by an office procedure. More complex but less common problems can also arise. These are from loss of support of the sidewalls of the nose called the nasal valve. The first thing you should do if you have difficulty breathing after a rhinoplasty is to discuss this with your surgeon. If these problems persist more than a year after surgery you might seek a second opinion from a rhinoplasty specialist.

It is impossible to say if your scar tissue is normal or abnormal without examining your nose. See your surgeon to find out what is going on.

What you describe sounds like it could be nasal synechiae, scar tissue that forms along the internal mucosa where the incisions were made for the turbinate surgery, rhinoplasty or the septum or both.  The strands of scar sometimes will attach to the nasal wall and the septum thus creating the pulling that you describe, as well as block air flow. Depending on where the scar is, how far up in your nose and how thick it is will determine the best way for you to move forward to remove it. Definately schedule an appt with your surgeon so he/she can take a look and go over your options.  Good luck!

Dear Fergi,

Breathing problems that occur after rhinoplasty may be due to many different problems.  While what you see may indeed be a scar formation, it could also be a result of weakening of the structural support of the nose.  Both can be corrected, albeit with different methods.  A proper examination by the original surgeon, or an ENT/Facial Plastic surgeon is imperative so that the right diagnosis and treatment can be offered.  Many times function is sacrificed for aesthetics, but if your surgeon is a rhinoplasty expert, this should not happen.  

Best of luck,

Dr. Michelle Yagoda, NYC

By six months, you should not have any unusual scarring within your nose at this point. I suggest that you get re-evaluated by your doctor.  Good luck.

Airway and breathing problems can occur with rhinoplasty, and as you have had the turbinates removed there must have been breathing problems even before the procedure. After six months your breathing should be better, and you should not see any scars or adhesion inside. Best to see your surgeon and let him have a look.
Best of luck,
peterejohnsonmd

Hello, after rhinoplasty it is generally a good idea to wait a year to assess the final result and before performing revisions.  You may have developed scarring near the internal valve, or near the incision for the approach to the rhinoplasty.  You should show your surgeon your concerns.