Very often I hear from patients whose airways were fine until they had rhinoplasty.  That should never happen.  Now they cannot breathe; they may have runny noses, they may awaken at night with dry mouths, they may have tried nasal sprays without effect, and they may have new trouble when exercising.  Some have already had septoplasties that haven’t helped.  Why not?

Every airway has two sides.  The septum is one side, and if it is deformed or deviated, it can block the airway.  However, the sidewall of the nose forms the other side of each airway, and must be strong enough in the middle and lower thirds (the internal and external valves, respectively) to stay open when you breathe.  If the valves are too narrow, or floppy, or otherwise unstable, your airway won’t be any good even if your septum is straight.

My airway research in 600 patients, as far as I know the largest such study ever performed, has shown that stabilizing either the internal or external valves – – even if no septoplasty is done – – will at least double airflow.  If both sets of valves are fixed, nasal airflow can triple or quadruple, even if the surgeon doesn’t touch the septum.  The valves are even more important to the airway than a straight septum.

So why does the airway get worse after rhinoplasty and how can you fix it?  When the surgeon removes a bump or narrows the tip cartilages, the remaining cartilages can be too weak to support the valves.  Treatment for the experienced surgeon is simple and virtually always effective.  We will discuss that next time.