Can My Breathing Difficulties From My Rhinoplasty Be Improved?

Q: Dr. Eppley, I had a minor rhinoplasty (for instance family and friends did not notice) three years ago.  I am happy with the result, but I cannot breathe at all out of the left nostril.  I believe it is nasal alar valve collapse.  I have to wear breathe right strips at night, and I have a product called Breathe With Eez – a small nasal expander that is a tiny stainless steel thing that I insert.  I have to use this constantly – needless to say, this is uncomfortable and inconvenient.  I cannot breathe well out of the right side either, but the left is much worse.  I do not want to alter the shape of my nose at all because I am very happy with the outcome aesthetically, but I need to be able to breathe.  When I told my surgeon, he told me that he could not believe I would complain because most people would just be happy to have such a nice looking result.  When I complained that he is an ENT and I can no longer breathe out of my nose correctly, he told me he could try and fix it but it would leave scars on my face (he would go through the undereye area)…he treated me like I was crazy to expect to be able to breathe right again, and I did not trust him, so I did not go back for this operation – he explained it in a manner that made it sound terrifying. I would like to discuss possibilities on how to remedy my poor breathing problem.

A: Nasal breathing difficulties after rhinoplasty are not historically rare, particularly when significant tip narrowing modifications are done. If not enough support is left to the lower alar cartilages, they can become weak and bow inward causing internal nasal valve collapse. This problem can be modified if there is also middle vault collapse from a profile reduction as well. While an examination would have to be done to be certain as to the exact reason for your breathing difficulty, there are some standard manuevers for secondary rhinoplasty improvement. These include alar batten grafts to stiffen up the bowed lower alar cartilage on the affected side as well as spreader grafts to the middle vault. These cartilage grafts may have some slight effect on your current aesthetic result but should be relatively minor.

Dr. Barry Eppley

Indianapolis, Indiana