A Patient With Nasal Valve Compromise

A 45-year-old woman presented with a complaint of nasal airway obstruction and a history of aesthetic rhinoplasty at age 20 years. She had been initially happy with the appearance of her nose, but over time, she felt that her nose had adopted a narrow, “pinched” appearance. She also noted gradually worsening nasal airway obstruction. After a 3-month trial of medical therapy failed, the patient was referred for further evaluation. Physical examination revealedanarrowmiddleone-thirdofhernoseanddeepalar grooves (Figure 1).Anterior rhinoscopyshowedasevereS-shapedseptaldeviation, worse on the left side. Rigid nasal endoscopy revealed narrowingof the internal nasal valves (INVs)bilaterally,with severe collapse on the right side (Figure 2).