The external nose (the part you can see easily on the outside) can also play an important role in nasal obstruction. The nostrils and area directly above them form what is called the nasal valve (see illustration below). This area is somewhat prone to collapse but can be particularly narrowed or easily collapsible due to a number of reasons, including congenital (at birth) factors or previous trauma or surgery. Rhinoplasty and nasal valve surgery are commonly used to treat nasal obstruction that originates at the external nose.

Rhinoplasty procedures are highly individualized, so your doctor should discuss the nature of the procedure as well as the risks and postoperative instructions.

What is nasal valve surgery?

Nasal valve surgery is designed to stabilize or support the side walls of the nose. This holds the nasal valve more open during breathing. Nasal valve surgery can be performed by itself or in conjunction with other nasal procedures. There are two approaches to nasal valve surgery:

• Cartilage pieces placed in the sides of the nose. This can be the cartilage removed during septoplasty (when performed at the same time as septoplasty) or additional cartilage that can be taken from one of the ear cartilages
• VivAer and Latera are treatments approved by the United States Food and Drug Administration in the past several years. Dr. Kezirian was among the earliest surgeons in the Western US who were trained and allowed to use VivAer and Latera.

VivAer console and handpiece

Latera nasal implant

Latera nasal implant system

How is nasal valve surgery using cartilage performed?

For placement of cartilage in the sides of the nose, a pocket is created on each sidewall of the nose through an incision inside the nose. On each affected side, a piece of cartilage designed to support the sidewall of the nose is placed into the pocket to support an area of narrowing or collapse. The incisions are then closed with stitches.

In addition to the potential for bruising and a minor risk of infection, the major risk associated with the procedure is a slightly wider or fuller appearance to the middle portion of the nose. Although the general appearance of the nose is primarily related to the nasal tip and the shadows at the tip (not affected by this procedure), there will a change in appearance. Because the cartilage graft is typically only 2-3 mm thick, this change in appearance may or may not be noticed by others. Other risks and postoperative instructions are outlined in the Septoplasty page.

How is nasal valve surgery using VivAer or Latera performed?

VivAer and Latera allow a surgeon to treat nasal valve collapse without the use of cartilage and with little to no change in the outside appearance of the nose. The VivAer technology uses a controlled cauterization of the sidewalls of the nose, resulting in limited scarring (not involving the skin) that stiffens the sides of the nose. The procedure can be performed in the office or the operating room.  There is an animation showing the VivAer procedure on the Aerin Medical company website.  Because the VivAer procedure results in small raw areas inside the nose, it is recommended that patients avoid pinching their nose or placing anything inside the nose other than some saline spray or gel for 3 weeks.  If patients need to blow their nose, they should do so gently. They should also avoid strenuous activity for two weeks.

The Latera implant is placed with a special needle-shaped device and can also be performed in the office or the operating room. Here is a video showing placement of the Latera implant: LATERA Animation.  Because the Latera implants are placed without any incisions, patients should not pinch or blow their nose for about a week after the procedure.  They should also avoid moving their nose side to side and also avoid strenuous activity for two weeks.  Finally, they should not place tissues or anything else inside their nose for about a month.

Frontal view of the external nose

Frontal view of the external nose, showing bone and cartilage

The following video presents a discussion of nasal procedures, including rhinoplasty and nasal valve surgery: