

Help! I can’t breathe after rhinoplasty! This is an unfortunate scenario that occurs all too often, either soon after or sometimes many years after surgery. Rhinoplasty has been a popular operation for decades, but unfortunately, even the best rhinoplasty surgeons have had experiences with difficulty breathing after surgery. 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”.
The nasal valve simply 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 blocked breathing. 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 Rite 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.
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 a number of 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. There are many techniques available, and you should ask your facial plastic surgeon what he or she can do to address your nasal valve problem if you suspect one.
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635 Madison Ave 14th Floor
New York, NY 10022
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