I Can Breathe Better Pulling My Cheek — What Does That Mean?
- Jan 10
- 5 min read
Updated: Feb 3
Many patients describe the same experience:
“If I pull my cheek sideways, I can breathe much better through my nose.”
This is not a coincidence, and it is an important clinical clue. In fact, it often points to a specific and commonly missed cause of nasal obstruction.
The Short Answer
If pulling your cheek sideways improves your breathing, it strongly suggests nasal valve collapse.
This means the narrowest part of your nasal airway lacks sufficient structural support and partially collapses when you breathe in.
What Is the Nasal Valve?
The nasal valve is the tightest point in the nasal airway and plays a critical role in airflow.
It sits:
Just inside the nostrils
Where cartilage, bone, and soft tissue meet
Because it is naturally narrow, even a small weakness can have a large impact on breathing.
Why Pulling the Cheek Helps you breathe better?
When you pull your cheek sideways, you are:
Manually widening the nasal valve
Preventing the sidewall from collapsing inward
Temporarily improving airflow
This manoeuvre is known clinically as the Cottle sign.
A positive Cottle sign (breathing improves when the cheek is pulled) is a strong indicator of nasal valve collapse.
Why This Is Often Missed
Nasal valve collapse is frequently overlooked because:
The septum may look straight
Scans can appear “normal”
The problem is dynamic (happens when you breathe in)
Routine examination may miss subtle collapse
This is why some patients are told:
“Everything looks fine — I don’t know why you feel blocked.”
Common Situations Where This Happens
Nasal valve collapse is more likely if you:
Have had previous septoplasty or rhinoplasty
Have a narrow nose naturally
Have had nasal trauma
Notice blockage during exercise
Are worse at night or on deep inspiration
Importantly, nasal sprays do not fix valve collapse, because it is a structural problem, not inflammation.
Why Septoplasty Often Doesn’t Help
Septoplasty straightens the septum but does not:
Strengthen weak sidewalls
Support the nasal valve
Prevent dynamic collapse
In some cases, septoplasty can even unmask valve collapse by removing internal support.
This explains why many patients say:
“My septoplasty didn’t work — but pulling my cheek still helps.”
What Actually Fixes the Problem?
The definitive treatment for nasal valve collapse is functional septorhinoplasty.
This involves:
Rebuilding structural support
Strengthening the nasal sidewalls
Supporting the valve area with cartilage grafts
Addressing septum, valves, and framework together
The goal is stable, reliable airflow, not cosmetic change.
Specialist Assessment Matters
Diagnosing nasal valve collapse requires:
Dynamic examination (watching the nose during breathing)
Understanding of nasal airflow physics
Experience with structural nasal surgery
Assessment in Hampshire is provided by Mr Tim Biggs, a Consultant ENT & Rhinology Surgeon with extensive experience in nasal valve reconstruction and functional septorhinoplasty.
Consultations take place at Adnova Clinic, with patients attending from Portsmouth, Southampton, Winchester, and across the South Coast.
When Should You Seek Help?
You should consider specialist assessment if:
Pulling your cheek improves breathing
Your nose blocks on deep inspiration
Symptoms persist despite nasal sprays
You’ve had septoplasty but remain blocked
Breathing worsens during exercise or at night
These are classic features of nasal valve collapse.
Key Takeaway
If you can breathe better by pulling your cheek, your nose is giving you valuable information.
This is not a habit, allergy, or coincidence — it is a sign of structural nasal valve weakness, and it requires a structural solution.
Correct diagnosis leads to correct surgery — and long-term relief.
To enquire or book an assessment:
📍 Adnova Clinic
More information:
Frequently Asked Questions: Breathing Improves When Pulling the Cheek
Why can I breathe better when I pull my cheek sideways?
If pulling your cheek sideways improves your breathing, this strongly suggests nasal valve collapse. The manoeuvre temporarily widens the narrowest part of the nasal airway and prevents the sidewall from collapsing inward during inspiration.
What is nasal valve collapse?
Nasal valve collapse occurs when the weakest, narrowest part of the nasal airway lacks sufficient structural support and partially closes when you breathe in. Even small degrees of collapse can cause significant blockage.
What is the nasal valve?
The nasal valve is the tightest point in the nasal airway.
It sits:
Just inside the nostrils
Where cartilage, bone, and soft tissue meet
Because it is naturally narrow, it is highly sensitive to weakness or instability.
What is the Cottle sign?
The Cottle sign is a clinical test where breathing improves when the cheek is gently pulled sideways. A positive Cottle sign is a strong indicator of nasal valve collapse and dynamic airway obstruction.
Why is nasal valve collapse often missed?
Nasal valve collapse is frequently overlooked because:
The septum may appear straight
Scans can look “normal”
The problem is dynamic (it happens during breathing)
Static examinations may not show collapse
This is why patients are sometimes told 'everything looks fine' despite persistent symptoms. You need a specialist who is trained to look for and manage this.
Can nasal sprays fix nasal valve collapse?
No. Nasal valve collapse is a structural problem, not inflammation. Sprays may reduce swelling elsewhere but cannot strengthen or support the nasal sidewall.
Why didn’t my septoplasty help if pulling my cheek still improves breathing?
Septoplasty straightens the septum but does not:
Strengthen weak nasal sidewalls
Support the nasal valve
Prevent dynamic collapse
In some cases, septoplasty can actually unmask valve collapse by removing internal support.
Is nasal valve collapse common after septoplasty or rhinoplasty?
Yes. Nasal valve collapse is more likely if you:
Have had previous septoplasty or rhinoplasty
Have a naturally narrow nose
Have had nasal trauma
Notice blockage during exercise or deep inspiration
Are worse at night
What is the definitive treatment for nasal valve collapse?
The definitive treatment is functional septorhinoplasty.
This involves:
Rebuilding structural support
Strengthening the nasal sidewalls
Supporting the valve with cartilage grafts
Addressing the septum, valves, and framework together
The aim is stable, reliable airflow, not cosmetic change.
Is functional septorhinoplasty cosmetic surgery?
No. Functional septorhinoplasty is performed to restore breathing and nasal stability. Any aesthetic change is secondary to correcting structure and airflow. However, cosmetic changes can be prioritised together with breathing function, if you so wish.
How is nasal valve collapse diagnosed properly?
Diagnosis requires:
Dynamic examination (watching the nose during breathing)
Understanding of nasal airflow physics
Experience with structural nasal surgery
This level of assessment is not part of a routine nasal exam.
Who should assess suspected nasal valve collapse?
Assessment should be carried out by a specialist ENT or rhinoplasty surgeon with experience in functional nasal surgery.
In Hampshire, assessment is provided by Mr Tim Biggs, a Consultant ENT & Rhinology Surgeon with extensive experience in nasal valve reconstruction and functional septorhinoplasty.
Consultations take place at Adnova Clinic, with patients attending from Portsmouth, Southampton, Winchester, and across the South Coast.
