Nasal Obstruction

Nasal Obstruction Patient Information

This information is provided to help patients understand the role of nasal surgery as a means to improve airflow through their nose.  This is general information only and is not a substitute for a physician consultation. It is not specific medical advice.

What is Nasal Obstruction?

Nasal obstruction means difficulty breathing through one side, or both sides, of your nose.

What Are Some Causes of Nasal Obstruction That Might Be Treated by a Facial Plastic Surgeon like Dr. Pepper?

A deviated septum and/or nasal valve collapse.

What is a Deviated Septum?

The nasal septum is made of cartilage and bone. It forms the “wall” that divides the right and left sides of your nose.  In some patients with difficulty breathing through their nose, the septum may be partially or completely blocking the nasal passages.  A deviated septum is one that is not in the midline of the internal nasal passages.  Instead, it skews off to one side of the nose and blocks nasal airflow on that side.

What is Nasal Valve Collapse?

From a patient’s perspective, “nasal valve collapse” refers to the tendency of your nostrils or the side of your nose to collapse inward when you breathe.  If you look in a mirror while you take normal breaths in and out through your nose, you may notice that the sides of your nose close off during inspiration (breathing in).  This is called “nasal valve collapse” and surgery may be able to improve this.  Surgery for nasal valve collapse typically requires taking cartilage from one part of your body, such as the nasal septum, and using this cartilage to reinforce the nasal valve (see below, “What is involved in surgical treatment of the nasal valve and a deviated septum?).

Are There Any Non-Surgical Options for Treatment of Nasal Valve Collapse?

Yes.  Breathe Rite™ strips may be quite effective in treating nasal valve collapse, particularly when worn at night or during exercise.  These can be purchased at any pharmacy without a prescription.  There are other over-the-counter devices sold by your pharmacy that are similar.  It is often recommended that patients try a non-surgical treatment like this prior to pursuing nasal valve surgery.

What is Involved in Surgical Treatment of the Nasal Valve & a Deviated Septum?

Although there are many ways to approach this problem, a typical surgery for nasal valve collapse and a severely deviated septum can include the following: under general anesthesia, an incision is made on the underside of the nose and connected to internal nasal incisions.  The surgeon may then perform a septoplasty, including removal of deviated portions of septal cartilage and bone.  Instead of discarding the deviated septal cartilage that is blocking nasal breathing, it can be used to create cartilage grafts, which are secured by the surgeon in key positions around the nose to strengthen and support the nasal valve and prevent collapse during breathing (see below).  The cartilage grafts are secured in place using sutures.  The nose is then carefully closed using sutures.  Some patients do not have enough cartilage in the septum for the reconstructive surgery.  This can be due to a prior septoplasty where cartilage was previously removed.  In these cases, cartilage must be taken from the ear or the rib during the same surgery in order to reconstruct the nose and improve nasal airflow.

What is the Role of a Facial Plastic Surgeon (like Dr. Pepper) in Treating These Problems?

Referring doctors may send their patient to a facial plastic surgeon if they suspect that certain surgical techniques will be needed to address the patient’s nasal obstruction.  A common example of this is surgical treatment of the nasal valve.  This is often accomplished by surgically “opening the nose” using an incision (shown above).  This allows the surgeon to perform a thorough septoplasty and also treat the nasal valve, if needed.  Nasal valve treatment often requires that the surgeon take cartilage from the nasal septum (or from another source, such as the ear or rib) and create a “graft.”  A cartilage graft allows the surgeon to create more space in the nose for airflow. This can be thought of as an “internal Breathe Rite™ strip” which helps keep the nostril open and supported during breathing.  There are many variations of these grafts, and selection of the graft is individualized by your surgeon.

Does This Surgery Change the Appearance of my Nose?

This surgery may cause some changes to the appearance of your nose.  The bridge of your nose may look slightly wider in order to allow more airflow.  Your surgeon can help you estimate what changes you can reasonably expect to your nasal appearance.   But in general, a nasal valve surgery will make the nose slightly wider.

Can I Make Changes to the Appearance of my Nose That I Desire at the Same Time?

In some cases, you may also choose to make changes to the appearance of your nose.  It is important to understand that these changes are cosmetic, not covered by insurance, and are part of a rhinoplasty surgery.  It is important that you notify us if you would like to discuss appearance changes to your nose, so that we can allow enough time for a rhinoplasty consultation.  This consultation will include a thorough discussion of nasal appearance in addition to nasal breathing.  The cost of cosmetic changes will vary depending on the surgical plan.  This can be estimated for you after a rhinoplasty consultation.

What is The Role of a Facial Plastic Surgeon (like Dr. Pepper) in Treating These Problems?

Some patients with nasal obstruction may want to simultaneously change the appearance of their nose.  A rhinoplasty consultation with a board-certified Facial Plastic Surgeon can help patients to make an informed choice about potential rhinoplasty.


Please call Dr. Pepper’s clinic at Stanford Facial Plastic Surgery at (650) 736-3223 if you would like to schedule a consultation.  Please be sure to specify if your consultation is for Nasal Obstruction alone, or for Nasal Obstruction and Rhinoplasty Consulation.   

Schedule a Consultation

(650) 736-FACE (3223)

Specify if your consultation is for Nasal Obstruction alone, or for Nasal Obstruction and Rhinoplasty Consulation.

Associate Professor of Otolaryngology - Head & Neck Surgery (OHNS)


Dr. Pepper is a double-board certified surgeon who specializes in aesthetic and reconstructive surgery of the face, in particular surgery for the treatment of facial paralysis. He is the Director of the Stanford Facial Nerve Center since 2017. He has broad expertise in facial plastic and reconstructive surgery, including facial reanimation surgery, facelift surgery, rhinoplasty, and the reconstruction of the face after skin cancer resection. Dr. Pepper performed his undergraduate studies at Brown University, majoring in Neuroscience. He completed a one-year research fellowship at the National Institutes of Health in preparation for a career in academic medicine. He was awarded his M.D. at the University of California, Irvine, graduating with highest honors and Alpha Omega Alpha designation in 2007. He went to the University of Michigan for residency training in Otolaryngology – Head & Neck Surgery in 2012. He then completed fellowship training in Facial Plastic & Reconstructive Surgery in 2013, also at the University of Michigan. Dr. Pepper was honored to receive the highest board score in the nation on the American Board of Facial Plastic & Reconstructive Surgery examination in 2013. For this accomplishment, he was given the Jack R. Anderson Award for Scholastic Achievement. He also directs the scientific work of the Stanford Facial Nerve Center and his NIH-funded research explores regenerative strategies to improve nerve regeneration after injury.