The Aesthetic Guide is part of the Informa Markets Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

Post-rhinoplasty breathing device

Article-Post-rhinoplasty breathing device

Sometimes, the simple things make a big difference.

Robert Kotler, M.D., clinical instructor of head and neck surgery at UCLA, got the idea for the Kotler Nasal Airway device in 2007, while consulting with a 29-year-old man about rhinoplasty revision surgery. Dr. Kotler knew he could fix the man’s nose, but the patient seemed more concerned about the airway blockage secondary to the necessary internal nasal packing than about repairing the functional and cosmetic concerns from his previous surgery.

When Dr. Kotler told the man that he required packing, the would-be patient said he’d rather walk out of the office than endure blocked nose recovery again, according to Dr. Kotler.

Dr. Kotler’s experience is that, in addition to the appearance, there are two other concerns that keep people from having functional and cosmetic nasal surgery. One is post-surgical pain. The other: whether they’ll be able to breathe after surgery.

“The question, ‘How am I going to breathe?’ is an important issue because many patients have heard the horror stories about their friends’ operations and how their noses were stuffed and their ears were clogged, and they were miserable. … that includes patients who had no packing inserted,” Dr. Kotler says.

To address the breathing concern, Dr. Kotler launched his patented Kotler Nasal Airway device in 2012. Surgeons easily insert the airway device into the nose, postsurgery, to help patients breathe normally. The FDA-cleared device is applicable for nasal and sinus surgeries — functional and cosmetic — whether surgeons use packing or not. No sutures are needed. The device’s silicone, soft, nonstick tubes are well tolerated for up to six days post-surgery; then, painlessly removed at the post-op visit, according to company literature.

Learn more about the new aesthetic innovations by checking out The Aesthetic Show.

NEXT: A Stand-Alone Airway


A Stand-Alone Airway

Rhinoplasty is the third most common cosmetic surgery in the U.S., according to the latest statistics by the American Society of Plastic Surgeons.

Dr. Kotler says the device improves the patient experience of that and other nasal surgeries for a small cost — about $70. In the case of functional nasal surgeries, surgeons are typically paid an additional surgical fee for placing it. And surgical facilities are eligible for insurance reimbursement to cover its cost.

Photo courtesy Dr. Robert Kotler.

“My sense is that this simple device differentiates the doctor who uses it from those who don’t use it,” he says. “A lot of patients are shoppers nowadays. They look at training, experience, credentials. Everybody has done a residency. Everybody is board certified. Many have done fellowships. They’re looking at before and after photographs and patient reviews and testimonials. Every doctor has a good story to tell. As if all are generic equivalents. However, if a prospective patient goes to three consultations and only one of those doctors uses the airway, then that doctor has now differentiated himself by a means the patient can understand. He is the only one who offers reasonable assurance of a better post-op experience.”

About 10,000 Kotler Nasal Airways have been used by surgeons, according to Dr. Kotler who designed and patented the device and manufactures it in Los Angeles.

“There has never been a known complication from it. None of them have ever torn or broken apart,” he says. “It’s a stand-alone airway. It doesn’t do anything else. It is not a splint, nor a stent. It has no influence on the surgery.”

NEXT: A Stand-Alone Airway


A Stand-Alone Airway

Dr. Kotler says that, depending on the patient’s anatomy, he often laterally fractures the inferior turbinates using a large, long speculum. His reasoning is that it gives a little extra room for insertion, but also gives the patient more breathing room.

To insert the Kotler Nasal Airway device, Dr. Kotler passes both tubes into the nose and seats them onto the floor. He checks the positioning of the tubes, making sure they’re resting on the floor of the nose, a silent area because it hasn’t been operated on. So, the tubes won’t damage the tissue. Nesting the tubes onto the floor of the nose assures a straight course back into the nasal pharynx and allows adequate room for any packing, if desired, according to Dr. Kotler.

Photo courtesy Dr. Robert Kotler.

Dr. Kotler then certifies patency by flushing saline through each airway, to make sure that they’re clear. Next, a thin suction catheter, provided with the airway, is passed through each air tube and into the pharynx, clearing secretions for the anesthesiologist. Anesthesiologists endorse the device, he says, because, using that same suction catheter, they can keep the pharynx continually clear without patient cooperation.

“No more having to cajole the often poorly cooperative patient, emerging from the anesthetic, to ‘Open your mouth, Mrs. Jones,’” he says.

For more about the nasal airway kit, which also includes a sterile syringe with a blunt time for home irrigation, go to

Hide comments


  • Allowed HTML tags: <em> <strong> <blockquote> <br> <p>

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.