Q: Dr. Eppley, I am interested in a septorhinoplasty procedure. I previously have undergone balloon sinus surgery in order to correct breathing issues. I have been to an ENT doctor and he suggested further reduction of the turbinates. I also have a problem with the sides of my nose collapsing when I breath in heavily. I wanted to correct the breathing problems especially because my chosen career is very physically based, as well as reduce a bump on my nose. I am very interested in if you would have any additional things to add to aid my breathing as well as improve the appearance for my nose. 

A: Having not seen any pictures on your nose or examined you, I can only make some speculative opinions based on your description of your nasal symptoms. While further reduction of your inferior turbinates may improve your breathing, collapse of the nasal sidewalls with inspiration suggests weakness of the lower alar cartilages and impingement of the internal nasal valves. Such nasal valve collapse can cause greater breathing difficulties than a mechanical obstruction of the inferior turbinates. Since you interested in taking down your existing nasal hump as part of a cosmetic change to your nose, the incorporation of middle vault spreaders to open up and stabilize the internal nasal valves as well as batten grafts to support the lower alar cartilages would be adjunctive nasal airway maneuvers in addition to the inferior turbinate reductions. This more comprehensive approach to your septorhinoplasty should provide some significant breathing improvement.

Dr. Barry Eppley

Indianapolis, Indiana