Nasal Valve Repair

What Is the Nasal Valve?

The nasal valve consists of internal and external components that constitute the greatest amount of nasal airflow resistance in the nose. The external nasal valve can be thought of as the nostril opening and its boundaries are the nasal ala, alar rim, septum, medial crura, and nasal sill. The internal nasal valve is located further inside the nose and its boundaries are the septum, head of the inferior turbinate, and the upper lateral cartilage. Conditions that narrow either the internal or external nasal valve lead to nasal obstruction or blockage.

What Is Nasal Valve Repair?

Correcting faulty nasal valves has the potential to improve nasal obstruction, which in turn improves nasal breathing. Internal and external nasal valve collapse involves different repair strategies. Most repair techniques involve adding stronger structural support, in the form of cartilage in the majority of cases, to promote valve patency. The internal and external nasal valves are often addressed during the same nasal valve collapse surgery.

Who Is a Good Candidate for Nasal Valve Repair?

A good candidate for nasal valve repair has one or more of the following conditions, including:

• Static internal nasal valve collapse
• Dynamic internal nasal valve collapse
• Static external nasal valve collapse
• Dynamic external nasal valve collapse

What Is the Relevant Anatomy for Nasal Valve Repair?

In order to adequately prepare for a nasal valves collapse treatment, the following structures need to be carefully assessed:

• Septum – A deviated septum can adversely affect the internal and external valve.
• Medial crura of the lower lateral cartilage – Short medial crura create a widened columella, which narrows the nostrils and can lead to nasal obstruction.
• Shape of the lower lateral cartilage – The paired lower lateral cartilages are the primary structural component of the external nasal valve.
• Nasal midvault – This region is defined by the attachment of the upper lateral cartilages to the nasal bones and the cartilaginous septum. Collapse or a weakened midvault can contribute to internal nasal valve insufficiency.
• Inferior turbinates – As part of the internal nasal valve, the inferior turbinate size and position are important. An overly hypertrophied inferior turbinate will reduce the internal nasal valve aperture and would need to be addressed at the time of the nasal valve collapse repair.

What Are the Types of Nasal Valve Repair?

Surgical nasal valve repair options

The main types of surgery that address internal and external nasal valve collapse repair include:

• Septoplasty
• Inferior turbinate reduction
• Spreader graft
• Alar rim graft
• Lateral crural strut graft
• Batten graft
• Tip ptosis repair
• Lower lateral cartilage repositioning
• Suspension sutures

Non-surgical nasal valve repair options

• Breathe Right nasal strips –  Worn on the outside of the nose to stent the external nasal valve in patients who are poor surgical candidates. Wearing these with good effect can be useful information if one becomes a candidate for nose surgery.
• Internal nasal dilators – Such as Airmax, can also be effective in some patients.
• Trimming of nasal hair – Studies have found that trimming the hairs in patients many nasal hairs is a low-risk, inexpensive way to improve nasal breathing
• Physical therapy – EMG biofeedback is helpful to improve the muscular stenting of the valve.

How Is Nasal Valve Repair Done?

A detailed review of the various types of nasal valve repair surgeries is provided, including:

• Septoplasty
  • Using an open or closed approach, the septum is accessed and deviated areas are removed or repurposed to create a straighter septum. Sometimes the septum is too tall in the vertical dimension and needs to be shortened to be straighter. A straighter septum will improve both the internal and external nasal valves.
• Inferior turbinate reduction
  • As part of the internal nasal valve, reducing the inferior turbinate can help improve nasal airflow. This is done by either out fracturing it with an instrument, doing a submucous resection and burning or chewing up the deeper tissue on the bone, or removing part of the turbinate bone.
• Spreader graft
  • A spreader graft is made of cartilage and is inserted between the dorsal (upper) septum and the upper lateral cartilage to widen the internal nasal valve. This can be placed using a closed or open approach, though an open septoplasty approach affords improved access and better confirmation of placement.
• Alar rim graft
  • An alar rim grafts help reinforce the nostril margin and improve the external nasal valve. It may not be enough to fully support a collapsing ala, as much of that has to do with the lower lateral cartilage, but an alar rim graft can help.
• Lateral crural strut graft
  • A stronger correction than an alar rim graft, a lateral crural strut graft supports most of the length of the lateral crura of the lower lateral cartilage. This provides shape and resilience to the ala to improve the external nasal valve.
• Batten graft
  • A batten graft is typically inserted through a closed approach and can be placed free-floating to reinforce the lateral nasal wall. The exact placement of the batten graft can be modulated to improve either the internal or external nasal valve, or both.
• Tip ptosis repair
  • A weak tip that collapses on gentle palpation or one that droops, may be a reason for external valve collapse. It can be improved with cartilage grafting to better support the nasal tip cartilages and to maintain a more open nasal airway.
• Lower lateral cartilage repositioning
  • Cephalically-malpositioned lateral crura are a significant contributor to external nasal valve incompetence. They can be dissected and reoriented to open the external nasal valve.
• Suspension sutures
  • A minimally invasive way to support the lateral nasal wall. It is used in facial paralysis patients and many others with valve collapse.

How to Prepare for Nasal Valve Repair?

Once you have decided to undergo nasal valve collapse surgery, Dr. Linkov will discuss in detail how to prepare for your surgery.

There are a few steps you should take before your nasal collapse surgery to get the best results. These steps include:

• Avoiding certain medications and supplements that may thin the blood, such as:
  • NSAIDS – ibuprofen (Motrin) and naproxen
  • Aspirin
  • Vitamin E
  • Garlic, Ginger, Ginseng, St. John’s Wort, Ginkgo, Black Cohosh
• Stop smoking at least 2 weeks before surgery, as tobacco products can decrease blood flow to the skin and compromise the healing of the surgical site
• Stop all nasal sprays 2 weeks before surgery, with the exception of saline which you can continue
• Pick up medications at the pharmacy, as you will be prescribed certain medications to take after surgery, such as:
  • An antibiotic
  • Pain medication
• Identify an escort home, as you will need someone to accompany you home and stay with you at least the first night

What to Expect on the Day of the Procedure?

On the day of your nasal valve repair surgery in Midtown, Manhattan, it is important not to eat or drink 6 hours before your nasal valve repair surgery. Most nasal valve repair surgery is performed under general anesthesia with an anesthesiologist, so there will be no pain during the surgery and you will have no recollection of the procedure.

You will be asked to change into a surgical gown and women of child-bearing age will need to take a pregnancy test. The intake process can take about an hour, the surgery usually takes 2-4 hours, and recovery will be about another hour.

What Is the Recovery From Nasal Valve Repair?

Recovery from nasal valve repair can be divided into time from surgery, such as:

• First 48 hours – Oozing from the nose is possible. Wear a drip pad under the nose to catch the spots of blood. Pain is usually mild to moderate and can usually be managed without narcotics.
• 1-2 weeks – Primary swelling and most bruising resolve in the first two weeks. Splints, casts, and sutures are removed typically at one week. Nasal stuffiness slowly improves.
• 8-12 weeks – The redness of the external incision, if used, diminishes. Tip swelling improves and can be aided by steroid injections.
• 3mo – 1 yr – Tip swelling continues to improve and eventually resolves leaving you with a final revision rhinoplasty result.

It is important to avoid strenuous activity such as exercise or heavy lifting for at least 1 week. Avoid contact sports for at least 6 weeks.

Nasal Valve Repair With Latera

Latera is a bioabsorbable lateral nasal wall stent, made of 70:30 copolymer of poly(l‐lactide) and poly(d‐lactide), that can be placed in the office or the operating room. The implant absorbs over the course of 18-24 months. The efficacy of the implant has been demonstrated for at least one year after placement. It is unclear exactly how long the results of Latera last.

Rhinoplasty for Nasal Valve Collapse

The nasal valve is comprised of two parts, one at the tip of the nose and the other farther back in the internal portion. Depending on the extent of the damage to the nasal valves, rhinoplasty is used to repair either one or both portions. Often, cartilage grafting is needed to reconstruct the nose structure to support the nasal valve.

This offers relief from breathing and sinus issues, as well as snoring and unhealthy mouth breathing. Internal nose valve collapse can accompany other unfortunate issues from a poor nose job. Dr. Linkov will perform nasal valve repair and a revision rhinoplasty during the same procedure, giving you the function and form you desire.

What Are the Risks and Complications of Nasal Valve Repair?

The risks and complications of nasal valve repair surgery include:

• Bleeding
• Infection
• Poor scarring
• Undesirable aesthetic result
• Upper dental numbness
• Asymmetry
• Bossae (tip irregularities)
• Overrotated tip
• Alar retraction
• Septal perforation
• Saddle nose (bridge collapse)
• Persistent nasal valve collapse
• Deviated nose

Are Patients Satisfied After Nasal Valve Repair?

Nasal breathing is an important quality of life factor for many people. If the nasal valves are found to be a contributor to nasal valve collapse and nasal breathing, then repair is recommended. In the well-selected patient who undergoes a nasal valve repair, the satisfaction is high. Attention must be paid to not significantly altering the cosmetic appearance of the nose. Dr. Linkov at City Facial Plastics in UES, Manhattan also performs many cosmetic rhinoplasty procedures and always factors in the aesthetics when offering functional nose surgery for nasal valve repair.

Who Is the Best Nasal Valve Repair Surgeon in NYC?

Patients often search for the best, top-rated doctor for nasal valve repair. Dr. Gary Linkov is a board-certified facial plastic surgeon in Manhattan, NY specializing in nasal surgery. Dr. Linkov is a specialist with extensive experience treating all conditions of the nose, especially those that have been previously operated.

He is the  Chief of Otolaryngology and Facial Plastic Surgery for the Veterans Hospital in Brooklyn, NY, where he operates on complex nasal deformities on our country’s veterans. Dr. Linkov’s private practice in Manhattan’s Upper East Side focuses on cosmetic and functional rhinoplasty and other nasal procedures.

If you have collapsed nasal valves, contact City Facial Plastics, located in Manhattan, NYC. We will schedule your consultation with the facial plastic surgeon in New York City, Dr. Linkov to discuss options to give you relief and possibly improve the aesthetics of your nose.

Dr. Linkov is a double board-certified by the American Academy of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology-Head & Neck Surgery. A native of New York, Dr. Linkov graduated as a salutatorian from Cornell University and received his Medical Degree at Columbia University College of Physicians and Surgeons. Dr. Linkov conducted advanced head and neck cancer research at the world-renowned Memorial Sloan Kettering Cancer Center. Dr. Linkov is a former Adjunct Assistant Professor at New York University (NYU), where he taught Rhinoplasty.

Dr. Linkov is a top-rated facial plastic surgeon in New York who specializes in lip lift, facelift, rhinoplasty, and hair transplant. He has been named one of the top 5 lip lift surgeons in the United States, is listed in the prestigious SuperDoctors New York™ registry, and has appeared on the Dr. Oz Show, where he discussed the state-of-the-art hair transplantation procedure.

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