Nasal airway surgery with Dr. Henry Sandel
Nasal Valve Repair
The nasal valve is the narrowest part of the airway. When its sidewall is weak it can draw inward as you breathe in — and the harder you inhale, the more it closes.
At a glance
Surgeon
Dr. Henry Sandel
Site
Narrowest part of the airway
Hallmark
Worse the harder you inhale
Method
Structural support or grafting
Basis
Typically outpatient
Also treats
Post-surgical collapse
Insurance
Out-of-network; may reimburse
Why the valve collapses
Airflow through a narrow channel creates negative pressure against its walls. A sidewall with enough cartilage support resists that pull. A weak one does not, and gives way on inspiration. This is why valve collapse characteristically gets worse with effort, and why patients describe breathing that fails exactly when they need it most.
Naturally thin or weak sidewall cartilage
Cartilage removed or weakened during a previous rhinoplasty
Injury or nasal fracture
Age-related loss of cartilage support
A narrow, or over-narrowed, nose
Scarring inside the nasal passage
Valve collapse is one of the more commonly missed causes of nasal obstruction, because attention usually goes to the septum first. It is also a frequent reason that breathing does not improve after septal surgery alone.
Signs the valve may be involved
A few patterns point toward the valve rather than the septum.
Breathing that worsens the harder you inhale
Improvement when you gently pull the cheek outward
Improvement while wearing an external nasal strip
Obstruction that persists after septal surgery
Difficulty breathing that is worse during exercise
Obstruction that began after a rhinoplasty
Dr. Sandel’s approach
When someone tells me their nose closes off when they take a hard breath in, that is the valve talking. It is a support problem, so the answer is to add support, not to take more away.
Related procedures
Insurance
Insurance does not cover surgery to change the appearance of the nose, but typically does cover treatment that is medically necessary. Dr. Sandel is an out-of-network provider, so where your plan offers out-of-network benefits, you would be reimbursed by your insurer directly. We provide the medical notes, procedure codes, and diagnostic codes to support that claim.
How the valve is supported
Repair is a matter of restoring structure rather than removing tissue. Depending on the anatomy it may involve:
Spreader grafts to widen and support the internal valve
Batten grafts to reinforce a collapsing sidewall
Strengthening or repositioning existing cartilage
Cartilage taken from the septum, or from the ear where the septum is unavailable
Correcting septal deviation at the same time when present
Rebuilding support that was removed during a prior surgery
Recovery
Nasal valve repair is typically performed as an outpatient procedure. Recovery resembles that of other nasal surgery, with congestion early and airflow improving as swelling resolves.
Swelling and congestion during roughly the first one to two weeks
A splint for about a week where external work is involved
Desk-based work usually within about a week
Strenuous activity held for roughly two weeks
Airflow improving steadily as internal swelling settles
Follow-up visits to monitor healing and breathing
Grafted support takes time to soften into its final contour. Breathing generally improves before the outside of the nose has finished settling.
Nasal Valve Repair FAQs.
An examination distinguishes them, and the two often occur together. The distinguishing feature of valve collapse is that the sidewall draws inward while you breathe in, which is why it is assessed during inspiration rather than at rest.
If an external strip, or gently pulling the cheek outward, improves your breathing, that points toward the valve. It is a useful clue rather than a diagnosis.
Your policy may pay for medically necessary parts of the procedure. Insurance does not cover surgery to change the cosmetic appearance of the nose. Dr. Sandel is an out-of-network provider. If your insurance company offers you out-of-network benefits, and you have a deviated septum, nasal valve collapse, or a broken nose — any of which with breathing issues not improved by medical treatments — then you could be reimbursed for that portion of the procedure. We will give you the medical notes, procedure codes, and diagnostic codes to help with this process.
Grafts are placed to support the airway, and the aim is a nose that looks the same or better. Spreader grafts can add slight width at the bridge, which is discussed beforehand.
Usually the septum. Where prior surgery has already used it, ear cartilage is a common alternative.
That is one of the more common reasons for valve repair. Over-narrowing, or removal of structural support, can leave the sidewall unable to resist inspiration.
Often, yes. Where both the septum and the valve contribute, addressing them together gives a better result than treating either alone.
Bring the breathing you actually have.
A consultation examines the sidewall while you breathe in, not just at rest — collapse that only appears on inspiration is easy to miss otherwise. Where a previous surgery is involved, the operative history matters, so bring what you have.