Feel like you’re living with a clothespin on your nose? You’re certainly not alone - an estimated 15% of the population struggles with persistent and severe difficulty with nasal breathing. This has far greater consequences than the occasional “mouth breather” quip from your friends. Beyond a source of embarrassment, nasal obstruction leads to difficulty sleeping and habitual snoring; limits endurance during physical activity; and worsens mood, memory, and productivity. While it may seem simple on the surface, nasal obstruction has a dramatic and well-studied quality of life impact.
One of the options out there to help people improve their nasal breathing is rhinoplasty, more commonly known as a “nose job.” That’s right - contrary to popular belief, they aren’t always for cosmetic purposes. Although of course you can both fix your deviated septum and get that Disney princess button nose while you’re at it.
Rhinoplasty is a fairly common operation with almost 214,000 Americans undergoing the procedure in 2018, according to the American Society of Plastic Surgeons. However, going under the knife is not a decision to take lightly, and it’s important to remember that all surgeries come with risks. It may be worth taking a look at some less drastic alternatives before taking that leap.
What can a rhinoplasty fix?
Functional nose jobs correct structural defects in the nose that prevent clear breathing.
Nasal valve collapse
The nasal valve is a fleshy region a centimeter or so beyond your nostrils, just before your nasal bone. Basically, it’s the furthest place into your nose you can still pick (if you still do that). It also happens to be the point of maximal resistance in your airway, and because it’s just tissue and cartilage (and not bone) it can be pretty soft and flexible. In many, it can be too soft and flexible. This is where the collapse comes in. Take a really sharp, deep breath in through your nose. If you see the sides of your nose bow inward, that’s nasal valve collapse. Even at rest your nose may be collapsing slightly when you inhale, and even a slight collapse can make it meaningfully harder to breathe. Poiseuille’s Law, anyone?
A deviated septum is a common problem where you may want both a functional and cosmetic procedure. It’s estimated that up to 80% of people have some degree of deviated septum, meaning the wall between the nostrils (the septum) isn’t straight up and down. Ideally the septum separates the nostrils equally in half, but a deviated septum bends and partially or fully blocks one or both nostrils. A deviated septum can be easy to spot, since it may make the nose crooked, but many cases actually aren’t visible and only impact breathing.
This is a broad category, but basically if you were born with a narrow or otherwise sucky nose (that is, a nose that cannot suck), a surgeon may be able to reshape your bone and cartilage to allow for improved airflow - and appearance if desired.
If you’ve suffered a broken nose or any other kind of nasal trauma that just didn’t heal right, rhinoplasty may be able to help. Under the umbrella of trauma, nasal surgery is ironically a major cause of nasal obstruction, especially if scar tissue and residual swelling obstruct the nose. Reoperation may be necessary in these cases to restore the airway.
What can’t it fix?
Deviated septums and nasal valve collapse are extremely common, but so are inflammatory conditions like allergies and sinusitis, which a rhinoplasty won’t fix (at least directly), so it’s important to figure out what exactly you suffer from. That said, many people do suffer from both nasal congestion (inflammation) and obstruction (structural problems), and addressing either one can make a huge overall difference in your breathing. For the best results, sufferers should work to address both causes.
In some cases, fixing the structural problem may even resolve the inflammatory problem. For example, improved nasal airflow after a functional rhinoplasty has been reported to relieve sinusitis symptoms by increasing the circulation of air in the nasal passages. That said, there are plenty of tried and tested methods for relieving congestion - more on that in other articles.
How can I tell if I have obstruction or congestion, or both?
Do a Cottle maneuver! Press your fingers into your cheeks right next to your nostrils and tug apart. Or, lift your cheeks and tug them apart. You can also try a more direct approach by tugging the soft sides of your nose directly. And if you’re feeling particularly brave, you can even press a Q-tip outward against the inside of your nose between the nostril and the nasal bone.
If you’re blown away by how well you can breathe, and you’re contemplating duct taping your cheeks apart, you are most likely dealing with a case of obstruction, and you may be a good candidate for rhinoplasty. If you’re not noticing any improvement, that’s likely congestion, which often takes place further back into the head, beyond the pesky nasal valve in the external part of your nose. If you’re on the fence, an Ear, Nose, and Throat specialist (ENT) could diagnose your situation in no time.
What are the pros and cons of rhinoplasty?
Best case scenario, surgery would be a one time fix for nasal obstruction. Once you’ve healed, you would ideally breathe clearly for the rest of your life. That’s not always the case. See: Cons.
If rhinoplasty is being performed to improve airflow, there is a good chance the operation can be covered by insurance. Cosmetic operations will not be covered.
But if you want to de-hump your schnoz at the same time, your surgeon may be able to make some cosmetic changes in the same operation, and the functional component may still be covered.
It’s an outpatient surgery, meaning you can go home the same day.
A nose job is usually not an option until someone is in their late teens or early twenties. Your face needs to stop growing first. Sorry, kiddos.
Functional rhinoplasty, particularly for nasal valve collapse, is an extremely specialized procedure that is performed by very few highly skilled (and very expensive) surgeons. Your local ENT may not be able to perform this procedure. You’ll typically need a facial plastic surgeon, which is a subspeciality of a subspeciality. Depending on where you live, you may need to travel to find one.
You may see unfavorable cosmetic changes, especially a slight widening of the nose.
Ironically, while functional rhinoplasty is the leading medical treatment for nasal obstruction, it is also one of its biggest causes. The nose is a complicated structure with a very small margin for error, and all the suturing, scarring, and swelling can make recovery unpredictable. Up to 40% of patients report unimproved or even worsened breathing post-operatively, and many will undergo multiple reoperations.
There will be some disruption to your routine. Most doctors will recommend avoiding physical activity for around a month and taking a week or two off work or school. And for good reason: a fresh nose job can look a bit… rough. You’ll wear a splint and may have some bruising and swelling around the nose and eyes. You may not want to leave the house at first, but things should be back to normal within a few weeks.
After you go under the knife there may be quite a delay before you notice improvement in your breathing. Post-operative swelling in the nasal passages will cause persistent nasal congestion and may not fully resolve for six months.
Surgery is never risk-free. You might have to deal with short-term complications such as a reaction to the anesthesia, infection, numbness, bruising, or bleeding. Long term complications can include skin discolouration, scarring, breathing difficulties, and nerve damage.
What are the alternatives?
Fair question, dear reader. Due to the potential complications of a functional rhinoplasty, you may not want to jump to the surgical option until you’ve tried some less risky, less expensive alternatives. There are plenty of over the counter options that are worth a try. Some target congestion (nasal inflammation), while others target obstruction (nasal structure).
These devices spray a fine mist of saline (salt and water solution) into the sinuses to reduce inflammation. They are an easy to use and often very affordable treatment for congestion - but not obstruction. Some sprays are medicated and contain more than just saline. We recommend avoiding these, as they are reportedly a bit addictive and can lose their effect over time.
A more traditional method is a Neti pot, a simple device you fill with a body temperature saline solution and pour in one nostril and out the other. This can flush out excess mucus as well as the allergens and pollutants that cause inflammation, and the saline itself works as mild decongestant. Looking for a very cute yet totally functional Neti pot, or a premade salt blend? Stay tuned.
Retrain your nose
You’d think we’d all be natural-born breathers given, you know, we’ve done it from the minute we’re born. However many of us are so used to mouth breathing that biologically superior nose breathing can feel too restrictive. In many people, nasal breathing actually can supply enough air - it’s just a matter of retraining yourself to rely on it. One simple exercise: try holding your breath until you’re feeling somewhat short of air (but not to a dangerous level, please!) and resume nose breathing to calm yourself in a few breaths. Repeat several times for a few minutes a day. You may be surprised how quickly nose breathing can become your new norm.
Relax, for once
Stress is a very unfortunate and very widespread byproduct of modern life. It can tense your muscles, causing you to breathe sharper and shallower, which is harder to do through your nose. Whenever you have a free moment, take a breather (literally). Check out our post on yoga breathing for some breathing exercises that can make a world of difference for your stress level and your nose.
Hale-AidLast but absolutely not least, there’s Hale-Aid. A small, comfortable, and easy to wear breathing aid. It’s a non-invasive, daily-wear option that gently holds your nasal passages open and offers you instant relief. We designed it to mimic the exact techniques world leading facial plastic surgeons use in their operating rooms. Hale-Aid instantly produces the best-case surgical scenario without the risk, expense, pain, recovery, or uncertainty. If you’re seriously considering surgery, Hale-Aid may be worth a try, if you don’t mind us saying.