Nares surgery is an intervention designed to improve nasal function and airflow by addressing structural issues within the nose. The term “nares” refers to the nostrils, the external openings of the nasal passages. This surgery often focuses on the nasal valve area, the narrowest part of the airway, which regulates nasal breathing. By repairing or reinforcing the structures around the nostrils and the nasal valve, surgeons aim to create a more stable and open nasal passage. The goal is to correct breathing difficulties that non-surgical methods, like nasal strips or sprays, cannot alleviate.
The Structural Issues Requiring Nares Surgery
The primary reason nares surgery is necessary is to correct mechanical instability that impedes the flow of air. This instability often manifests as nasal valve collapse, where the sidewalls of the nose narrow or fall inward during inhalation, restricting the airway. The nasal valve is divided into the internal nasal valve and the external nasal valve, both susceptible to collapse.
Internal nasal valve collapse involves the area where the upper lateral cartilage meets the nasal septum. External nasal valve collapse affects the nostril rim, supported by the lower lateral cartilage. Cartilage weakness is a contributing factor, which can be congenital or acquired.
Structural deformities requiring intervention often arise from trauma, such as an accident or sports injury that compromises the nasal framework. Previous nasal surgeries, like rhinoplasty, can unintentionally weaken supportive cartilage, leading to later collapse. Aging can also cause cartilaginous support to weaken and droop, resulting in gradual collapse and difficulty breathing.
These structural issues lead to persistent symptoms like chronic nasal obstruction, a sensation of blockage, and difficulty breathing through the nose. Patients may experience noisy breathing, snoring, or a need to breathe through the mouth, negatively impacting sleep quality and daily function. Surgical correction is often prompted to reinforce the nasal structures when non-surgical methods fail.
Specific Surgical Procedures for Nares Repair
Surgical repair of the nares focuses on structural reinforcement using various grafting techniques. The specific procedure selected depends on whether the internal or external nasal valve, or both, are compromised. The goal is to widen and stabilize the airway to prevent tissue collapse during inhalation.
A common technique is the use of spreader grafts, which are thin strips of cartilage placed between the upper lateral cartilage and the nasal septum to widen the internal nasal valve angle. These grafts are typically harvested from the patient’s own nasal septum, or from the ear or a rib if the septum is insufficient. Strategically placing spreader grafts physically props open the narrowest part of the mid-vault, enhancing airflow.
For external nasal valve issues, surgeons often use alar batten grafts. These are small pieces of cartilage placed laterally near the nostril rim to reinforce the weakened lower lateral cartilage and prevent sidewalls from collapsing inward. Another technique, the alar rim graft, involves placing a thin strip of cartilage along the nostril rim to provide support and prevent the edge from retracting.
When cartilage is severely damaged or insufficient, a caudal extension graft may be used to lengthen and strengthen the support of the nasal tip and columella. This provides a strong foundation, especially in revision surgeries or cases of significant structural loss. Less invasive techniques, such as specialized internal sutures, can also reposition and stabilize existing cartilage. Autologous tissue (the patient’s own cartilage) is favored for all grafts due to its excellent long-term compatibility.
The Recovery and Post-Operative Experience
The immediate post-operative period requires careful management to ensure proper healing and minimize discomfort. Patients should anticipate swelling and bruising around the nose and possibly the eyes, which typically peaks within the first 48 to 72 hours. Pain is manageable with prescribed oral medication, and keeping the head elevated, even while sleeping, helps reduce swelling.
Many patients wake up with nasal packing or internal splints placed inside the nose to support repaired structures and control bleeding. These are usually removed by the surgeon within the first week, often providing an immediate improvement in breathing. External splints or casts may also be applied to the bridge of the nose and are generally removed around one week after the operation.
Short-term recovery involves restricting physical activity for several weeks to prevent injury and manage blood pressure. Patients must avoid strenuous exercise, heavy lifting, and any activities risking trauma to the nose for at least three to six weeks. Gentle nasal hygiene, often involving saline rinses, is encouraged during this time to keep passages clear and promote internal healing.
While most swelling subsides within the first month, the nose continues to heal over a much longer period. Full functional results and the final aesthetic outcome may take up to a year or more to become evident as internal tissues settle and grafts integrate. Patients should monitor for signs of excessive bleeding, fever, or persistent, worsening pain, which warrant immediate communication with the surgeon. Long-term success depends on adhering to all post-operative instructions and allowing adequate time for the reinforced structures to heal.