Difficulty Breathing after Rhinoplasty. What’s the best graft to make my nose bigger and restore my breathing? (Photos)

Thank you for your question and for sharing your photographs.

The characteristics you are demonstrating appear to be due to a combination of muscle activity around the nostrils and some flexibility in their structural support. Controlling muscle activity in this area is more challenging, so the focus is typically on reinforcing nostril support.

This is often achieved using ear cartilage grafts, though in some cases, stronger support may be required, necessitating rib cartilage. If your previous surgery did not use cartilage from the septum and it remains available for grafting—though this is uncommon—it can also serve as a good source for reinforcing nostril support.

You have both internal valve and external valve collapse. The internal valve will need to be strengthened with spreader grafts with upper lateral cartilage overlayed on tension; additionally the lateral crura of the lower lateral cartilages need to be reset to a 90 degree resting angle, which would occur with a proper tip complex reset. The lateral crura of the lower lateral cartilages may also need batten grafts, as well. The external valve would also be strengthened by above maneuvers but would also benefit from alar grafts.