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Client Testimonial

I had persistent nasal blockage following two failed rhinoplasties. Dr. Khosh reconstructed my nose allowing me to breathe comfortably and look normal again. His professionalism and skill is outstanding. I felt comfortable and well informed throughout the process. I highly recommend Dr. Khosh to anyone considering nasal reconstruction.

Alex, Manhattan, NY

Learn More

The nasal valve is the internal aspect of the front the nose; where the greatest resistances to airflow normally occur. The BreathRight strips worn by football players on the field help to keep the nasal valve open during vigorous exercise. Although nasal valve collapse during vigorous inspiration is normal, its collapse during normal breathing is abnormal and can results in nasal blockage, snoring, and mouth breathing. Patients with nasal valve collapse often pull up the cheek on the affected side to breath better.

Nasal valve obstruction is an often-overlooked cause of nasal obstruction. The commonest cause of nasal valve collapse is previous rhinoplasty; followed by nasal trauma, and congenital weakness of the nose cartilages. Examination of patients with nasal valve collapse will show pinching of the nose and dynamic collapse of the nasal sidewalls during inspiration. Individuals with previous rhinoplasty often manifest stigmata of an overdone nose job, including a pinched or over narrowed nose.

Although internal or external stents can improve nasal obstruction from nasal valve collapse, they do not offer a permanent solution to the problem. The most appropriate treatment for nasal valve obstruction involves restoring structural support to this area of the nose. The nasal valve can be divided into an external and an internal portion. The external nasal valve is situated low in the nose in the nasal tip region. The internal nasal valve is higher, in the middle third of the nose. Surgical correction of one or both parts of the nasal valve requires cartilage grafting to add support and stability. In rare occasions when the nostrils were excessively narrowed during cosmetic rhinoplasty, a composite graft of skin and cartilage is used to widen the nostril.

Dr. Khosh is an expert in diagnosis and treatment of nasal valve obstruction. He published one of the first scientific articles, in the Archives of Facial Plastic Surgery, pertaining to management of nasal valve obstruction. Dr. Khosh has lectured nationally and offered seminars on the "Prevention and treatment of nasal valve collapse during rhinoplasty". If you suffer from nasal obstruction following rhinoplasty or nasal trauma, we invite you to schedule a private consultation with Dr. Khosh, to learn about the cause and the treatment options.

  • 2013 Castle Connolly Top Doctor®
  • 2013 Best Doctors in America®
  • 2013 Patients' Choice award
  • 2010 Patients' Choice Award
  • 2008-2009 & 2010-2011 Best Doctor List.
  • Past President of New York Facial Plastic Surgery Society.
  • Assistant Clinical Professor at Columbia University.
  • Past Director of Facial Plastic Surgery at Columbia Univeristy.

Case Study

This 37-year-old requested consultation for repair of nasal obstruction following two rhinoplasty attempts. There was evidence of internal and external nasal valve collapse. An open rhinoplasty approach and septum cartilage grafts were used for repair of the nasal obstruction.

  • Patient: 37-year-old requesting consultation for nasal obstruction following rhinoplasty
  • Problem: Bilateral internal and external nasal valve collapse
  • Procedure: Repair of nasal valve obstruction with cartilage graft


What kind of anesthesia is used for repair of nasal valve collapse?
Surgical correction of nasal valve collapse can be performed under sedation or general anesthesia in an operating suite.
Will repair of nasal valve collapse make my nose look ugly?
No. In cases of severe nasal valve collapse, the "pinched" appearance of the nose is corrected after nasal valve repair. In cases where the nose is not "pinched", nasal valve repair has minimal to no effect on the cosmetic appearance of the nose.
What can be used for nasal valve repair, if there is no cartilage left in my nose?
Nasal valve repair requires cartilage for structural support of the nose. If there is no cartilage left inside the nasal septum, ear cartilage, or rib cartilage may be used.
What is a composite graft for repair of nasal stenosis?
A composite graft is a generic term that describes a graft that has more than one component. In nasal vestibular stenosis, combination grafts of skin and cartilage can be used from the ear. This provides stability and tissue coverage for a narrowed region of the nose.
What is a spreader graft for repair of nasal valve collapse?
Spreader grafts in nasal reconstruction describe vertical bars of cartilage that are used to widen a narrow nasal dorsum.
What is an alar batton graft in nasal reconstruction?
Alar batton grafts are cartilage grafts that are placed horizontally or obliquely in the nostril region to stabilize and strengthen the lower part of the nose.

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