One of the most common complaints patients have after rhinoplasty is a new runny nose (rhinitis). If it existed before surgery, rhinitis can indicate allergies. When it appears only after surgery, it’s not allergies. There are two common causes.
The more common one is a new airway obstruction. When the surgeon reduces the height of the bridge and reduces the tip cartilages, both the internal and external valves, respectively, can become incompetent. That means the sidewalls collapse on inspiration or the nose is no longer wide enough to permit normal airflow. Instead of passing smoothly through the nose, the air spins around and dries the lining. That makes the nose run. When the valves and any other causes of obstruction are corrected, the rhinitis often disappears in a few months.
The second cause, less common, is excessive reduction of the inferior turbinates. There are three pairs of turbinates, and the lowest (inferior) ones primarily warm and humidify the air so that, no matter how cold and dry it is outside, when the air reaches your lungs it is almost 100% humidity and almost body temperature. That’s a lot of work being done in about 6 inches.
The turbinates can enlarge when the nose is obstructed, but this is not a primary turbinate problem, it is usually a valvular or septal problem. In other words, the turbinates themselves are not abnormal – – they are large because of the other abnormalities. My published 600-patient airflow study has proven that.
I only crush and outfracture the turbinates so that they are no longer too large and take up less space, but still function normally. I have taught this conservative approach for years, and other surgeons are now adopting it, which is good for patients.
If the turbinates have been reduced excessively, the nose will run even if the airway is otherwise good. That is a problem for which there is no solution that always works.
It is most important to identify the real causes of airway obstruction and not over-treat them.