Difficulty breathing after rhinoplasty? The cause of complications that those pursuing "aesthetics alone" encounter
Many people struggle with "inexplicable difficulty breathing" after rhinoplasty.
- Structural causes of impaired respiratory function after rhinoplasty
- The true nature of the "nasal valve" that causes post-operative complications
- Correct surgical techniques and revision methods to preserve respiratory function
After all, getting your ideal nose only to experience disruption in daily life would defeat the purpose, wouldn't it?
"Swelling will resolve it"—is that a myth? The real reason for breathing difficulty after rhinoplasty
Immediately after surgery, nasal obstruction due to anesthesia, internal bleeding, and tissue swelling is a completely normal reaction. For this reason, many clinics explain, "Your breathing will become easier as time passes." However, if the sensation of breathlessness persists even after several months, it is likely not merely swelling but rather a problem with the internal structure of the nose itself.
In fact, the impact of rhinoplasty on respiratory function has been reported in medical research. In a study by Burstein (2008), it was noted that "reductive rhinoplasty"—where cartilage and bone are shaved down for cosmetic purposes—removes part of the nose's support structure and may have a direct impact on respiratory function. (DOI: 10.1097/PRS.0b013e31817b45a0)
Why does breathing sometimes become compromised after undergoing surgery to become more beautiful? This time, let's start by understanding the structural mechanism behind "why breathing becomes difficult."
What is the "nasal valve (nasal cavity valve)" that controls nasal airflow?
The majority of cases where rhinoplasty causes breathing difficulty stem from problems with the part called the "nasal valve." The nasal valve is the narrowest part of the nasal cavity and functions like a "valve" that controls resistance in the airway.
The nasal valve is broadly divided into the "internal nasal valve" and "external nasal valve." The internal nasal valve refers to the area surrounded by the nasal septum (the wall dividing the left and right sides of the nose), the caudal end of the upper lateral cartilage (cartilage on the side of the nose), and the cephalic portion of the inferior turbinate (the fold inside the nose). This is the most flexible and narrowest part of the nasal airway and plays a critical role in regulating airflow and resistance. The external nasal valve, on the other hand, refers to the space from the nasal entrance to the internal nasal valve and is composed of the lower lateral cartilage and the base of the nose.
Can design-focused rhinoplasty become a cause of breathing problems?
This is the most common question asked during consultations. "Doctor, how much thinner and higher will my nasal tip become?" In pursuing a beautiful nose, reductive rhinoplasty—which makes the nose thinner, smaller, or higher—is extremely popular.
However, if in pursuit of beauty alone, the cartilage supporting the nose is excessively removed or forcefully compressed, the structural integrity of the entire nose may be severely compromised. This "loss of support strength" is said to be one of the causes of "dynamic collapse," where the nasal ala (nostrils) caves inward when taking a strong breath. In particular, those with naturally thin skin and weak cartilage may experience collapse of the external nasal valve if excessive cartilage removal is performed.
Online, you sometimes see claims like "cutting a lot of cartilage to make it as small as possible is the best approach," but a different perspective is generally reported. Excessive tissue removal carries the risk of causing long-term nasal valve stenosis and serious respiratory difficulty.
Furthermore, in extreme cases, when the nasal cavity becomes excessively enlarged due to excessive removal, a special condition called "Empty Nose Syndrome" has been reported. This tends to occur after excessive removal of the inferior turbinate and similar structures. Despite the nasal cavity being physically wide open, disrupted airflow (turbulence) or improper function of the mucous membrane sensors can result in severe nasal obstruction sensation, suffocation sensation, and even panic—an extremely distressing complication. In reality, how can we achieve both beauty and function?
What are the "Spreader Graft" and "Butterfly Graft" that protect respiratory function?
To achieve both function and beauty, it's not enough to simply refine the design—a process of properly "reinforcing" the weakened nasal structure is essential. This is where the cartilage grafting techniques called "Spreader Graft" and "Butterfly Graft" become extremely important in modern rhinoplasty.
Spreader Graftis primarily used to prevent narrowing of the internal nasal valve. In the technique reported by Sheen (1984), cartilage precisely adjusted to approximately 20–25 mm in length, 3–4 mm in height, and 2–3 mm in thickness is generally wedged between the nasal septum and the upper lateral cartilage like a wedge. (DOI: 10.1097/00006534-198403000-00001) This physically widens the narrowed internal nasal valve, ensuring an open airway, while also maintaining a straight and beautiful nasal dorsal line over the long term. Additionally, there are reports that processing the graft to have a trapezoidal cross-section can more efficiently widen the nasal valve.
Butterfly Graftis a technique using ear cartilage (auricular cartilage) and transplanting it to the nasal dorsum in a shape like a butterfly with its wings spread. In a study by Clark and Cook (2002), this graft was adjusted to approximately 2.2 cm in length × 0.9 cm in width for women and approximately 2.5 cm in length × 1.2 cm in width for men. (DOI: 10.1001/archfaci.8.6.379Post-operative satisfaction at 6 months was reported at 87.3%. In a follow-up study of 72 patients undergoing secondary rhinoplasty (revision surgery) using butterfly grafts, 97% (70 patients) reported improvement in nasal airway problems, and simultaneously 86% (62 patients) reported satisfaction with aesthetic improvements. However, treatment effects vary among individuals, and it has been reported that some patients experienced no visible change (11%) or perceived worsening (3%), meaning that similar results cannot be expected for everyone.
Post-operative breathing discomfort—how much can revision surgery improve it?
If you happen to develop difficulty breathing after rhinoplasty at another clinic, you may worry that "you might have difficulty breathing for the rest of your life." However, there are examples reported in medical research of improvements in respiratory function through appropriate revision surgery.
In a study by Andrews et al. (2015), an investigation was conducted on 122 patients (78 males, 44 females, mean age 33.5 years) who underwent septorhinoplasty. (DOI: 10.1002/alr.21535)As a result, the pre-operative average NIPF (nasal inspiratory peak flow: an indicator of the maximum amount of air that can be inhaled rapidly through the nose) was 88.2 L/min, while post-operatively it improved significantly to 101.6 L/min (P = 0.0064). Additionally, the SNOT-22 score (sinusitis and nasal symptom score), which evaluates subjective symptoms, was reported to have improved dramatically from a pre-operative 48.6 to 26.6 at 3 months post-operatively. However, treatment effects vary among individuals, and similar improvements cannot be expected for everyone.
Furthermore, in a study by Kim and Jang (2019), the NOSE score (nasal obstruction symptom evaluation score) was measured in 29 patients (mean age 33.4 years) who underwent correction of caudal (lower) septostasis (deviation) and placement of batten grafts (reinforcing cartilage). (DOI: 10.3342/ceo.2018.01234)As a result, the pre-operative NOSE score showed severe nasal congestion with an average of 62.1, but it was reported to have decreased significantly (improved) to 9.2 at 2 months post-operatively (P < .001). However, surgery carries risks.
Revision surgery involves more tissue adhesion and scar formation compared to the initial surgery, requiring exceptionally high-level technical skill and experience. For this reason, choosing a surgeon who understands not only the surface design but also the hidden internal "structure" and "air dynamics" is more important than anything else.
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Summary of this article
- The main cause of difficulty breathing after rhinoplasty is narrowing of the "nasal valve," which adjusts the airway passage
- Design-focused surgery that excessively removes cartilage can reduce support and increase the risk of breathing problems
- Cartilage grafting with spreader grafts or butterfly grafts may reinforce the nasal structure and improve breathing
- Even if problems occur, improvement in respiratory function has been reported through professional revision surgery, though results vary among individuals and risks are involved
If you have any concerns, please feel free to consult with us first. Zetith Beauty Clinic provides consultations based on medical evidence.
References
- Andrews P, Choudhury N, Takhar A, et al. The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer?. Clinical Otolaryngology. 2015 (DOI)
- Burstein F. Prevention and Correction of Airway Compromise in Rhinoplasty. Annals of Plastic Surgery. 2008 (DOI)
- Apaydin F. Nasal Valve Surgery. Facial Plastic Surgery. 2011 (DOI)
- Toriumi D, Pero C. Asian Rhinoplasty. Clinics in Plastic Surgery. 2010 (DOI)
About the author of this article
Hiromitsu NakamuraPhysician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
With a track record of research presentations at domestic and international academic conferences, he is also involved in technical instruction and education for Zetith Beauty Clinic as a whole. He specializes in precision rhinoplasty based on anatomical evidence and pursues natural results tailored to each individual's skeletal structure and tissue.