How common are breathing problems after Rhinoplasty?

Nasal valve collapse isn't typical after rhinoplasty as long as your surgeon respects the need to maintain (or augment) your nasal support during your surgery.I use a structure based rhinoplasty approach in which this philosophy is a central tenet. This involves avoiding over-resecting nasal cartilage or bone. To support the nasal valves spreader grafts or alar batten grafts are cartilage grafts that can be used to properly support the nose after surgery. You can read more about these types of grafts at my web reference link below.

Most people do have issues breathing after the surgery due to the congestion which is normal. There shouldn't be any long term effects with breathing issues after the surgery since usually it was done to help with breathing. these are things you should consult with your surgeon about .

In the first couple of weeks, temporary congestion is common. In the longer term, nasal obstruction is very unusual. This is mainly an issue following reduction rhinoplasty performed by a surgeon that doesn't take into account that making a nose smaller can create serious breathing issues if the structure of the nasal airway isn't maintained. I recommend that you seek a consultation with a surgeon who chooses to focus on rhinoplasty and has performed, at a minimum, hundreds of rhinoplasty procedures both aesthetic and reconstructive. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

It's important to examine the internal portion of the nose to make sure there is no  pre-existing deviated septum, turbinate hypertrophy or valve collapse prior to any elective cosmetic nasal  surgery. It is also important to prevent valve collapse  from occurring at the time of surgery, such as a spreader graft placement. It's important to  evaluate for both internal valve collapse and external nasal valve collapse. For more information about spreader grafts, please see the video below

It is probably more common than people think. However, I do see a disproportionate amount of patients with breathing problems since I am also an ENT physician. I have patients that seek out my services for other cosmetic issues who may have had rhinoplasty 10-15 years before and when asked they will admit to having breathing issues. Nasal valve collapse and a persistent deviated septum are probably the most common reasons for breathing problems after rhinoplasty. The nasal valve can be collapsed at either the external nasal valve (due to the tip cartilages being over-resected) or at the internal nasal valve when the bridge is lowered (dorsal hump removal). Preventing nasal valve collapse comes from understanding the structural anatomy and being conservative in the approach. Also, spreader grafts, flaring sutures and/or proper osteotomies to close an open roof deformity can be used during the time of surgery to prevent future problems. 

Breathing problems after the rhinoplasty swelling has resolved do happen, but we don't see that very often as long as the supporting cartilages are not overly altered. If it appears likely, the surgeon may place cartilage strut grafts to help hold the airway open. The risk can go up when the patient undergoes too much surgery on the nose.