One of the most common reasons for continued nasal congestion despite allergy medications and even nasal surgery is due to flimsy nostrils. Your nose comes in various shapes and sizes, but having naturally thin nostrils or weakened nostrils after rhinoplasty can lead to flimsy nostrils that collapse during even quiet inspiration.
Unfortunately, many people undergo a number of different medical treatments using allergy sprays or even surgery before this condition is even considered.
There are three simple ways to tell if you have flimsy nostrils:
1. look in the mirror and take in a deep breath through your nose. Do the sidewalls of your nostrils cave in as you breathe in?
2. place your index finger just beside your nostrils on both sides. While pushing gently on each side, pull the cheek skin up and away from the nose, towards the outer corners of the eyes. Breathe in and see how you feel.
3. take off the cotton ends from two Q-Tips and place the thin end inside your nostril and lift up and sideways. Take a deep breathe in. Is your breathing much improved?
One very important point to make here is that how stuffy your nose is on the inside can also determine how much your nostrils will collapse. Think of sucking through a flimsy straw. If you pinch the middle slowly, the end will collapse since there's increased airflow. The same thing happens with your nostrils. In many cases properly addressing intranasal allergies or a deviated septum and enlarged turbinates will prevent the nostrils from collapsing.
If you use over-the-counter decongestants like Afrin or Sudafed and you can breathe much better, then you need to address the inside of your nose first. But if you still have nasal congestion and it's obvious that your nostrils are caving in, then you have flimsy nostrils, or nasal valve collapse. Lifting up your nostrils by pulling your cheeks apart or using Q-Tips is a good test to see if you have this condition.
If treating your allergies or deviated septum or enlarged turbinates don't help, then there are two major ways of treating this problem:
1. Nasal dilator devices.
These come in two varieties: external and internal.
External devices are mainly over-the-counter adhesive strips that attach to the nostrils on the outside that pulls the nostrils apart. This works for most people, but for some people with thick or oily skin, it may not work as well.
Internal nasal dilator clips. There are a number of these devices, including Nozovent, Sinus Cones, Breathewitheez, and Brez. You can find any of these devices online.
2. Surgery
The most common way of managing this surgically is through a functional nasal reconstruction procedure, using rhinoplasty techniques. Small strips of cartilage (harvested from either the nasal septum or the ear) are placed under the skin of the nostrils and between the septum and the cartilage of the lower part of the nose. There can be a little widening of your nose due to added support structures.
A newer and easier way of addressing flimsy nostrils is to make a tiny incision under the lower eyelid and attach a thin suture the bone. The suture is then threaded under the skin towards the floppy nostril area, looped about the nostril, and tunneled back out of the eyelid incision, and tied under a mild degree of tension. This suspends the nostril so that it doesn't fall in. This procedure can be performed under local anesthesia and it literally can take about 30 minutes and recovery is very quick. Unlike the more formal procedure, your nose is less likely to widen, since you're only suspending or "hanging" your nostrils to the bone above.
