Treating Nasal Valve Obstruction: The VivAer Procedure Explained

[Mary Ashmead MD]
All right. So, for those patients who do respond well to the modified Cottle in the office, and so you can kind of mimic the types of results you can get with a radiofrequency procedure. Like VivAer we talk about it. And I show them videos of what we can expect. This is what to go through. And sometimes we will kind of piggyback this with turbinates as well, if we have other problems. But if they respond well to that modified Cottle in the office, we have really good data to say that they will respond to the VivAer procedure. And it's data that lasts out to four years now. That we get lasting relief from this office procedure that we can offer our patients who don't want surgery, and they don't want to change the outside of their nose and they are having trouble breathing through their nose. And so then we start to go through exactly what it is and how it works and, uh, whether or not this would be a good option.

[Ashley Agan MD]
And for listeners who don't know what it is, can you kind of do your spiel about [the VivAer]. What is it?

[Mary Ashmead MD]
Yeah. So, VivAer is a disposable handpiece or stylist that delivers bipolar radiofrequency energy. So it's a little paddle that we can use to shrink down this tissue and to help, to stiffen and retract and change and remodel that internal nasal valve. And so there's a video, an animation on their website that I will show them say, this is what we're trying to accomplish. And then they usually ask, well, what's radiofrequency energy, you know, how does this work? And I tell them that it causes tissue vibration that causes things to heat up. And so if you put this against a grape, it makes that grape kind of slowly implode because they immediately think burning, right? Like, oh, you're going to go burn my nose. No, that's not what we're doing. This is it's temperature controlled. It does not overheat this little paddle that delivers this energy in a way that will remodel and reshape that small area that's most important. And so we talk a little bit about the nasal valve and how, this is the area that's the smallest and the nose. And we talk a little, very small amount about physics, which is always a good time. But there's no incisions. And in the end, you can do this in the office and, we can give you some relaxing medication beforehand, or you can, we can numb everything up, and you can drive yourself home and go straight back. And recovery is minimal. And so we talk about this, this procedure and go through the details. So the short answer is that this is a remodeling we're trying to remodel the inside of your nose so you can breathe better.

[Gopi Shah MD]
Is there any sort of rebound intra-nasal swelling for any of these locations that you have to tell them about or, is there any, and I know we, so it didn't affect the way the appearance of the noise, but do you ever have any temporary, external swelling or anything?

[Mary Ashmead MD]
Yes. So we talk about all of those things. So like any radiofrequency procedure, really it's six to eight weeks before it's really completely finalized. Right? So just like when you use coblation technology or anything else in, within the nose or turbinates. It does take some time for that to completely finalize. The other thing that you do get, you get a crust and this is the most annoying part for the patient. And I tell them this, like, you know, the procedure is very easy and recovery is very easy, but you're going to get this little scab on the inside of your nose, where we do this, this little nasal valve procedure. And that can stick around for several weeks. I do have them, use ointments. I have them use ointments twice a day until that scab goes away. I will sometimes switch them over after a couple of weeks to just something like saline gel or something that is not petroleum based. But we talk about that scab and like, it's going to be better sooner, but it will be even better when the scab.

You do also tend to get some tenseness on the tip of the nose. So what I tell patients and with their family members there, you know, “tomorrow, you may look at the tip of your nose and think, oh, that looks a little swollen, or it feels tense or tight. Like when you've had a sunburn and your skin feels tight, it's not going to look different to someone who doesn't know you”. I've had patients go straight to the grocery store after the procedure. So you don't look different, but it does feel a little bit tense, or feel a little bit tight for a few days. I give my patients an optional little pulse dose of prednisone. I just do, I do 40 milligrams once a day for five days. And I tell them that this is optional. Steroids have side effects. And we go through those. But I want you to have this on hand, my procedure days on Fridays. And so I want you to have this so that if it feels tense or it feels uncomfortable, you can take this. If you're doing great, you don't have to in the long run. This is not going to make any difference with healing, but in the short term, it can make it a little bit more comfortable. And this is an option for you that I want you to have.

[Ashley Agan MD]
Anything else that you counsel to look out for? Does the nose look red and swollen or anything, or is that the worst? It gets just a little bit of tip tenseness.

[Mary Ashmead MD]
Yeah. A little bit of tip tenseness. And then that scab that's really it. I have had no other problems. It's a little sore, like it's bruised on the outside. So if you manipulate the nose and that can stick around for a few weeks it doesn't hurt at baseline. But if you hit it like, oh yeah, it's a little bit sore. Not really a risk for infection or anything else because of the nature of the process of the handpiece itself.

[Ashley Agan MD]
And so patients probably can just get by with Tylenol Motrin. So I'm like probably aren't requiring narcotics?

[Mary Ashmead MD]
I usually give them a couple of Tramadol. For my patients that I premedicate, for my nervous people. We talk, we go through all of this kind of extensively. We could talk about anesthesia protocols for a couple hours. So I'll give them a couple of Tramadol to take ahead of time. And then there's a couple extra there in case they need it. I've never had anybody ask me for more than that though.