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PROFILES Modern Rhinoplasty Textbook

External Nasal Valve Collapse

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Procedure Details

An often confused and overlooked component of the nasal airway is the external nasal valve. The external nasal valve refers to the mobile alar wall (the sidewalls of your nostrils). The nasal valve is located about 1cm from the nostrils, between the septum and the cartilage of the outer sidewall of the nose. Because this area is naturally the smallest cross-sectional diameter of the nose, any alterations or irregularities to the nasal valve can cause a drastic change in airflow.

Some people are born with external nasal valve irregularities that impede airflow. For others whose cartilage was otherwise normal, obstruction secondary to external valve compromise is most commonly due to:

  • Previous Surgery. An overly aggressive previous surgery is the most common cause of nasal valve collapse or compromise. Most often, external valve collapse occurs after previous nasal surgery in which too much of the nasal tip cartilages was removed. Without these supporting cartilages, the nasal valve is unable to perform its proper function. These cases truly highlight the importance of choosing skilled, experienced rhinoplasty surgeons who can take the delicate nuances of the nasal structure into account.
  • The Aging Process. The effects of aging can be very detrimental to the cartilage and tissues surrounding the nasal valve. With age, ligaments that normally support the nasal tip and valve areas start to stretch and lose support. The undermining of this supporting structure can also cause the nasal valve to narrow from its proper shape and size, obstructing airflow.
  • Trauma. Physical trauma to the face can damage its underlying structures, and can especially be harmful to the delicate nasal regions. The nose can also be more susceptible to trauma as it protrudes from the face. Trauma can take many different forms and any change to the nasal valve region can hinder its performance. Common sources of traumatic nasal valve collapse include a nasal fracture or broken nasal bones which cause the nasal bones to shift along with the mid-vault or middle portion of the nose. This shift can cause narrowing or compromise of one or both nasal valve areas. Occasionally, a severe blunt trauma to the nose may cause the delicate attachments of the supporting mid-vault and tip cartilages to become detached or avulsed, which can lead to collapse of the nasal valve areas.
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There are several treatment options for an external nasal valve collapse or compromise. A common, non-invasive treatment option is the use of external nasal strips, which pull open the valve. These are commonly worn by professional athletes to improve airflow during athletic competition. However, these are only a temporary solution. Moreover, because they are highly visible and can be considered unsightly, many of our patients do not consider the long term use of nasal strips to be a viable solution.


A permanent solution to external nasal valve collapse is a surgical procedure. Each patient and each case will vary, as the structures of the nasal passageways are different for every patient; therefore, the surgical techniques involved with each patient’s solution can vary as well. In many cases, the surgery required is minimally invasive and can be performed as an outpatient procedure, with a minimum of downtime. However, in cases where the external nasal valve collapse is accompanied by further nasal structural weaknesses, a more extensive rhinoplasty may be necessary. This may be more common in cases of poor previous surgical outcomes and a revision rhinoplasty may be required.

Drs. Solieman and Litner will have a thorough discussion with you during your consultation about your specific condition and their proposed treatment plan that is best suited for your nose to restore your nasal function to the highest possible level.

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