Functional Septorhinoplasty - The Nasal Valve

If you're struggling to breathe comfortably through your nose, there may be a structural cause that can be corrected. Today, I'll explain one of the most important factors in nasal airflow: the nasal valve - and how functional septorhinoplasty can help. The nasal valve is the narrowest part of your entire nasal airway. It sits just inside your nose, where the cartilage of your nasal sidewall meets the central septum. Because it's so narrow, even small changes here can have a significant impact on how easily air flows when you breathe in. When you inhale, air speeds up as it passes through this narrow area. This creates a drop in pressure inside your nose, which can cause the soft sidewall to be pulled inward, and partially collapse. If your nasal structures lack sufficient support and are weakened due to trauma, previous surgery, or congenital factors - this collapse restricts airflow and makes breathing feel effortful. This explains why some patients still feel blocked even after previous nasal surgery - or even worse, due to compromise of the essential nasal structure caused by not well planned surgery. The septum is not always the problem — the valve itself may be the critical factor limiting airflow. Research on elite athletes has shown that nasal valve collapse persists even after extensive septal, and turbinate surgery affecting overall performance. Common symptoms include - persistent nasal obstruction; difficulty breathing during exercise or sleep; and a sensation of having to work harder to draw air through your nose. Some patients also notice their nostril visibly collapsing inward, when they breathe in deeply. Assessment begins with careful clinical examination; I look for dynamic collapse as you breathe, and use the modified Cottle manoeuvre to distinguish between structural narrowing and lateral wall weakness. Photographs help assess tip support, and nasal projection. Flexible endoscopy allows detailed examination of the internal valve angle; septum; and turbinates. CT scanning is reserved for complex, or revision cases. Functional septorhinoplasty is not simply about appearance - it's about restoring comfortable breathing while maintaining natural facial harmony. The nasolabial angle, and tip projection should be corrected carefully but attention to maintaining and preserving the tip supporting mechanisms, and the integrity of nasal pyramid. My goal is to support the valve area and strengthen supporting structures, so your nose both looks and functions as it should. Surgery is typically an open approach septorhinoplasty - performed through a small inverted V columellar incision, that heals well. With careful planning using pre operative photographs, and assessment in clinic prior to surgery, I can precisely identify areas of weakness or narrowing and address them directly. This approach means smaller scars, less discomfort, and faster recovery. One of the most effective techniques is the spreader graft; This involves placing a small piece of cartilage between the septum and the upper sidewall cartilage to widen the internal valve angle. This improves both the static opening of the airway, and provides structural support to resist collapse during breathing. For patients whose sidewall collapses during breathing, I may use alar batten grafts, or butterfly grafts to reinforce the lateral nasal wall. These increase structural stiffness, preventing the nostril from being drawn inward on inhalation. In selected cases - flaring sutures or spanning sutures can further stabilise the valve without additional cartilage grafting. Maintaining strong tip support is essential for valve function. Including techniques such as the columellar strut, a cartilage graft placed between the nostrils to help stabilise the nasal tip. Also, the tongue-in-groove method allows precise adjustment of projection and rotation, while reinforcing overall structural integrity. Some patients have what we call a tension nose - where overdeveloped cartilage causes over-projection and narrowing of the internal valve. Careful surgical correction reduces projection while preserving tip support, improving airflow dynamics and nasal balance. Each case requires individualised planning based on underlying anatomy, and functional goals. I regularly manage complex cases, including revision surgery - where previous operations have not fully resolved symptoms; reconstruction following trauma; and patients with significant facial asymmetry. These situations demand meticulous planning, realistic expectations, and a layered approach to structural rebuilding prioritising airway restoration. Most patients recover well within a few weeks and notice improved breathing once swelling settles. If nasal obstruction is affecting your quality of life, a detailed assessment can identify the cause. Please contact my team to arrange a consultation and discuss your options.