The airway must be evaluated as a complete system.
The nose warms, humidifies and filters the air we breathe, and obstruction usually has more than one cause. We evaluate structure—the septum, nasal valves and turbinates—and physiology—the lining of the nose, allergy and sinus disease—together, because treating one source of obstruction while missing another can leave a patient still blocked.
The septum is the wall between the two sides of the nose. When it is deviated, it narrows one side, and septoplasty straightens it. The nasal valves are separate structures and are often mistaken for a deviated septum.
The internal nasal valve lies about one centimeter inside the nose, where the upper lateral cartilage meets the septum. The angle between them is commonly described as 10 to 15 degrees in white patients and varies in other populations. It is the narrowest part of the nasal airway and accounts for roughly half of its resistance, so a small loss of width can have a large effect—much like a straw pinched at one point. The external nasal valve is the nostril opening, bounded by the alar rim, lower lateral cartilage and nostril sill.
Valve obstruction may be static or dynamic. A static obstruction is a fixed narrowing caused by anatomy, such as weak or displaced cartilage, a deviated septum, or over-resection during a prior operation. A dynamic obstruction occurs when the sidewall appears adequate at rest but collapses inward during inhalation.
The diagnosis is clinical. During the Cottle maneuver, the cheek is gently drawn outward while the patient breathes in. The modified Cottle supports the sidewall from within. These maneuvers help determine whether the valve contributes to the blockage. Endoscopy completes the examination, and the valve is also observed without a speculum, which could temporarily open it and conceal the problem. External nasal strips or internal dilators can serve as a therapeutic trial and help indicate what structural support may achieve.
When surgery is appropriate, treatment is matched to the valve and the type of obstruction. Internal-valve narrowing may be treated with spreader grafts, which widen the angle and support the middle vault, or with flaring sutures. External-valve weakness may require alar batten grafts or alar rim grafts to strengthen the sidewall and rim. For selected patients with dynamic collapse, an absorbable lateral-wall implant may be another option.
The lining of the nose can obstruct breathing as much as the framework. Rhinitis—inflammation of that lining—may be allergic, non-allergic, sometimes called vasomotor rhinitis, or mixed. Each is treated differently.
Medical treatment comes first and continues alongside surgery when needed: saline irrigation; intranasal corticosteroid sprays as first-line treatment; and antihistamines when allergy is present. When the history suggests allergy, skin-prick or serum IgE testing can identify triggers. If immunotherapy is planned, its timing is coordinated with the allergist.
We aim to control rhinitis before surgery so that the lining is quiet at the time of the operation, early healing is more predictable, and symptoms caused by inflammation are not later mistaken for a surgical result.
The inferior turbinates are ridges of bone covered by swellable lining along the sidewalls of the nose. They warm, humidify and filter inhaled air. The turbinates naturally swell and shrink in an alternating pattern through the day—the nasal cycle. With chronic inflammation, the lining can change at the cellular level and the turbinate may remain enlarged through its soft tissue, bone, or both. When this obstruction no longer responds to medication, surgery may be appropriate.
Our protocol combines electrocautery ablation of the soft tissue—energy applied beneath the lining to shrink it—with a controlled micro-fracture of the turbinate bone. The bone is repositioned rather than removed, and the lining is preserved.
Historically, turbinate tissue was sometimes removed generously. A small number of patients developed empty nose syndrome: dryness, crusting, and a distressing sense of suffocation or air hunger despite a nasal cavity that appears widely open. The condition is uncommon, its true incidence is unknown, and agreed diagnostic criteria remain limited. It has also been reported after conservative turbinate procedures, so no technique eliminates the risk completely. Treatment is possible but difficult.
Function and structure are inseparable in the nose. We therefore preserve normal tissue and treat only as much turbinate as the obstruction requires.
A CT scan of the sinuses is obtained when the history supports it, such as recurrent or chronic sinusitis, nasal polyps, prior sinus surgery, or symptoms that persist despite medical treatment. The scan can be graded with the Lund–Mackay score to describe the extent of disease.
Extensive disease is generally treated first with functional endoscopic sinus surgery, allowed to heal, and followed by nasal surgery. Limited disease may be treated during the same operation in selected patients. Studies of combined sinus surgery and septorhinoplasty support that approach in appropriately selected patients at low or moderate risk, but not in complicated sinus disease. When the disease extends beyond the scope of facial plastic surgery, we coordinate care with a rhinologist.
Expect the nose to feel more blocked than before for the first several days — swelling, not failure, and it reliably surprises patients. Splint removal is set individually at the pre-operative visit. Most patients take about a week off.
Congestion improves steadily and most patients notice a real change in their breathing during this window. Saline mist spray keeps the inside of the nose moist. No heavy lifting, exercise or bending, and no nose-blowing, for two weeks; crusting is common and settles, and bleeding that will not stop is a reason to call.
Full internal swelling resolution — and the complete breathing benefit — is typically appreciated by around three months. Where cartilage grafts were used to support the nasal valve, the framework continues to stabilize beyond that, and any subtle external contour change settles over the same period.
A deviated septum, valve narrowing, turbinate enlargement, rhinitis and sinus disease often overlap. The purpose of the consultation is to identify which factors are present, which are driving the symptoms, and which can be improved with medical treatment before surgery is considered.
Few results feel as immediate to a patient as breathing comfortably through the nose again at night.
Septoplasty is an internal operation on the septum, performed through incisions inside the nose to relieve obstruction. Rhinoplasty reshapes the outer nasal framework. Septorhinoplasty is both in one operation. Septoplasty cannot straighten a crooked nose from the outside; a cosmetic rhinoplasty that ignores the airway can leave breathing worse than before.
It depends which structure is obstructing you. A bent septum needs septoplasty. Enlarged turbinates need turbinate reduction. A collapsing sidewall needs nasal valve repair — part of functional rhinoplasty, not septoplasty. Most patients with significant obstruction have more than one cause; the answer comes from an examination, not a questionnaire.
Usually yes, when medical necessity is documented: persistent moderate-to-severe obstruction for twelve weeks or longer, a physical exam identifying the structural cause, and a documented trial of medical management. Nasal valve repair additionally requires age 18 or older and counselling on dilator strips or cones first. Our office handles pre-authorization and confirms approval before surgery. Cosmetic work is never covered.
It depends on whether the septum is actually causing the obstruction and how severe symptoms are. In the largest randomized trial, benefit scaled directly with baseline severity — moderate-symptom patients gained about 5 points, extreme-range patients about 30. And if obstruction comes from turbinates or the nasal valve, septoplasty will not help. Both are reasons the examination matters more than the diagnosis you arrive with.
The pattern is a nose that works at rest and shuts down on hard inhalation. If pulling your cheek outward, or wearing a nasal strip, makes a clear difference, that points to the sidewall — neither maneuver can move a septum. A useful clue, not a diagnosis; the two conditions frequently coexist.
Yes — and it is a common reason patients seek a second opinion. Septoplasty leaves the valve untouched, so someone whose obstruction was always valvular gets no relief. A rhinoplasty that closed the roof without spreader grafts narrows the internal valve; over-resected tip cartilage can cause external collapse years later. If breathing worsened after nasal surgery, the valve is the first place to look.
Dilator strips and cones give temporary relief and are expected to be tried first. An absorbable lateral wall implant placed in-office dissolves over about eighteen months; more than 80% of patients were responders at two years in its randomized study, with 9% experiencing migration or removal. In-office radiofrequency suits selected patients. None of these equals structural graft repair, and the published data do not support claiming otherwise.
Short-term effects can include crusting, dryness and bleeding. Empty nose syndrome is an uncommon but serious condition involving dryness, crusting, and a sense of suffocation or air hunger despite an open nasal cavity. Its incidence is unknown, diagnosis remains difficult, and no technique eliminates the risk entirely. It can be treated, but with difficulty, which is why Dr. Kim preserves the lining and bone and treats only as much turbinate as the obstruction requires.
The first week feels more congested than before — swelling, not failure. Splint removal is set individually; published data favor days four to seven. Most patients take a week off. Breathing improves steadily through weeks two to four; the full benefit is appreciated around three months. No heavy lifting, exercise or bending for two weeks; no nose-blowing for two weeks.
Smell usually improves, because air can finally reach the olfactory area. In the randomized septoplasty trial, about 11% of patients reported an altered sense of smell after surgery — in most cases temporary. Permanent loss is rare but possible, and it belongs in the consent conversation.
It frequently reduces snoring and improves sleep quality, but does not reliably cure obstructive sleep apnea — that is driven by collapse at the palate and tongue base. The strongest case for nasal surgery in an apnea patient is making CPAP tolerable, often allowing lower pressures and a nasal rather than full-face mask. We recommend a sleep study before surgery for heavy snorers or anyone who wakes unrefreshed.
Septoplasty and turbinate reduction are internal and not intended to change the outside — the randomized trial nonetheless recorded a noticeable external change in about 10% of patients. Nasal valve repair adds structure and can subtly change the middle third, usually toward slightly fuller and straighter. Cosmetic changes can be addressed at the same time and billed separately, or not addressed at all.
Patients from New York City stay at our guest house in Syracuse for the first week and return home after the one-week visit, when sutures are removed. Patients from Rochester stay at a local hotel the first night and then return home, and they return to Syracuse for the one-week visit.
Examination, nasal endoscopy and long-term follow-up take place at whichever office is closest to you.
Syracuse / Central New York. 4939 Brittonfield Pkwy, Bldg B, Ste 208, East Syracuse, NY 13057. Syracuse office →
Rochester. 70 East Boulevard, Rochester, NY 14610. Rochester office →
Manhattan / Sutton Place. 347 E 53rd St, Suite Lobby A, New York, NY 10022. Manhattan office →
If you are travelling in for surgery, the office coordinates the pre-operative visit, the operative date and the follow-up schedule around one trip wherever possible. Request a consultation →
"I can finally breathe through my nose again. Dr. Kim explained everything clearly and the whole team made me feel at ease."
"Excellent care from consultation through recovery. Highly recommend."
"Professional office, great communication, wonderful results."