If you’re having trouble breathing through your nose after a rhinoplasty procedure, a nasal collapse may have occurred. A nasal collapse is a situation where one or more parts of the nose have experienced a loss of structural integrity and may seem deflated or otherwise malformed. 
Rhinoplasty involves reshaping and removing the cartilage of the nasal skeleton. Nasal collapses are usually a result of over-resection, which is when too much cartilage has been removed. The heaviness of the skin becomes more than the remaining cartilage can bear. Thus, people with thicker skin are more likely to experience this situation. Other reasons for a nasal collapse include nose injuries and aging (the side walls of the nose sometimes weaken with age).
The nasal skeleton is very complex. Over-resection when removing imperfections like nasal bumps from the upper lateral cartilage (near the middle of the nose) can cause this area to collapse, resulting in an “inverted V” deformity. A collapse can also occur when too much cartilage is weakened or removed from the middle nasal vault area, leading to a “saddle nose” or “boxer’s nose” deformity.
Lower down on the nose is the lower lateral cartilage, the area above the nostril and right near the tip of the nose. When this cartilage is weakened, nasal valve collapses can occur. Broadly, the nasal valves are the nostrils. More specifically, the largest, most visible part of the nostril is called the external valve. The narrow area farther inside the nostril is called the internal valve. Breathing in through the nose creates a vacuum that pulls in the nasal side walls. When the external or internal valves are weak, the action of breathing in is enough to cause a collapse.
How can you tell if you’ve experienced a nasal collapse? First, check your nose for symptoms. External valve collapses are usually easier to notice than internal. External collapses affect the rounded outer parts of the nostrils, called the alae, making them look flimsy and deformed. With an internal valve collapse, on the other hand, the nose’s middle third sometimes develops a slight hourglass appearance.
It’s also helpful to determine whether you have a functional or a structural valve collapse. With functional valve collapses, the valve looks normal when you’re not breathing. When you’re breathing in through your nose, the valve collapses inward rather than opening wider. Structural valve collapses are a bit more obvious; when you’re not breathing, the valve appears deformed, and when you’re breathing in, the valve does not widen at all.
It’s very important to see a physician if you suspect that a collapse has occurred. If your physician uses a tool like a nasal speculum to open the valve, you may end up with a false diagnosis; stabilizing the valve with a tool changes its behavior. It’s more helpful to cut some of the larger, thicker nose hairs, called vibrissae, before your appointment, giving the physician a better view of the problem area.
The Cottle test is an effective way to diagnose the issue. This test involves pulling the cheek gently to one side to open the nasal valve; this way, there’s no stabilization. If it’s easier to breathe while pulling the cheek, there may have been a collapse.
Dr. Farhad Rafizadeh is a skilled, board-certified cosmetic surgeon, and his record of success speaks for itself. Set up a consultation with Dr. Rafizadeh to learn more about the risks and rewards of rhinoplasty.