05 Nov I can’t breathe after a Rhinoplasty
Help! I can’t breathe after nose job! Rhinoplasty has been a popular operation for decades, and this unfortunate scenario thankfully occurs only rarely. However, it can happen either soon after or sometimes many years after surgery, making it a sometimes-difficult problem to properly diagnose. Luckily, today we are in an era of improved understanding and new techniques. An important aspect of this is our new understanding of a region known as the “nasal valve”.
What is the nasal valve?
The nasal valve refers to the areas of the nasal air passageway that provide the greatest resistance to airflow – anything that is blocking it, or causing collapse during breathing, can lead to the sensation that you can’t breathe after nose job. The most difficult part of the valve to diagnose and treat is the “lateral nasal wall”, which just means the side walls of the nose. If you’ve ever tried Breathe Right strips and felt improvement, then you are familiar with the effect of the lateral nasal wall on breathing. This part of your nose has very little cartilage for support and tends to be naturally weak. Because of this, the lateral wall tends to move with normal breathing, falling inwards when you breathe in. If you have had a rhinoplasty that has created or worsened this problem, it is frequently because the cartilage support of this area was removed or weakened during surgery.
Can the nasal valve be treated?
There are many options for treatment of the nasal valve, but the key is proper diagnosis by the plastic surgeon. Pieces of cartilage known as “spreader grafts” can open the narrowest part of the nasal valve and provide greater airflow. For the sidewalls, there are also several options. Implantable devices and radiofrequency treatments can be performed in the office setting to treat mild collapse the lateral walls, avoiding an extensive surgical procedure. There are also a host of surgical techniques that can be used, including cartilage grafting to reinforce the support of the side walls. In some cases, a reconstructive rhinoplasty operation with cartilage grafting may be required to rebuild the entire bottom part of the nose – this is frequently needed for severe obstruction, especially if the tip is distorted after a prior rhinoplasty operation. Often this cartilage is obtained from rib cartilage. Some of these techniques can be quite advanced, so you should discuss the specific plan with your surgeon in detail.
So, if a patient comes to me saying they can’t breathe after nose job, the first thing I look at is the integrity of the nasal valves, as this is often the culprit behind this difficult problem. I try to determine very specifically what part of the nasal valves is dysfunctional, and come up with a hypothesis as to why it is like that. In the case of revision rhinoplasty, where surgery was performed before, it helps to review any operative reports may be available for this purpose. I have had excellent results with complete rebuilds of the nasal tip and sidewalls to restore the ability to breathe after previous rhinoplasty surgery.
So is there hope if you can’t breathe after nose job? The short answer is yes! However many techniques exist, so it is important to ask your facial plastic surgeon is what he or she can do to specifically address your nasal valve problem.