In his Beverly Hills practice, facial cosmetic surgeon Dr. Robert Kotler encounters many patients who can’t breathe.

This can be because of allergies, sleep apnea, unfixed broken noses, deviated septum or nasal blockage.

Often a problem, like a deviated septum, combines with enlarged turbinates (the narrow and curled bone shelf—shaped like an elongated sea-shell—which protrudes into the breathing passage of the nose) to block air passages. Or colds or allergy cause swelling that completely shuts the airway.

And there are the patients with difficulty breathing who say, “I don’t get allergies; but my breathing gets worse when I sleep.”

“There are a lot of people walking around who can’t breathe,” Kotler said.

“People get hooked on nose sprays and medications—that row of the pharmacy—and nothing works,” Kotler said

The operation to fix the problem is “nothing new and underutilized,” Kotler said.  Straightening a deviated septum and trimming turbinates has been done for 100 years, he says.

ducing the turbinates makes the nose passages larger, Kotler said. “It make a two-lane highway into a four-lane. Even if allergies block  the air passages there is twice the room so patients can still breathe.”

       The biggest hurdle for many patients, Kotler says, is having to endure the cotton “packing” required after the procedure. Typically doctors fill 90 percent of the sinus cavity so the soft tissues will stay where the doctor left them and to reduce the chance of bleeding. Patients are left feeling like they’ve got a clothespin holding their nose closed.

For some, the inability to breathe normally causes anxiety and claustrophobia, Kotler said.

The mouth breathing dry throat, the bad breath that can result, plus the loss of  smell, especially when eating, combine to create an experience that makes patients say “this is no fun,” Kotler said.

“The light came on,” Kotler said, when he encountered a patient who’d broken his nose, was not happy with the look of his nose and who also couldn’t breathe. “I told him we could fix it all in one operation. And he said, ‘if you put packing in I‘m out of here—I can’t stand it.’”

“I thought, if this is the one thing stopping him from a lifetime of comfort. I was going to give him two drinking straws in his nose.”

But he came up with something better. Two silicone tubes that can be shortened to match the length of the nasal passage.

The multi-component system/kit is centered on a one-piece, two-tube nasal airway appliance inserted by the surgeon at the end of the operation, at the same time as the packing.

The “back opening” of the tube sits just forward to the end  of each nasal passage, beyond the area of packing, yet not abutting the back wall of the upper throat.

“It’s a nifty thing. I thought wow, how come after 35 years and 4,000 nose cases, I hadn’t thought of this before.

Kotler, who’s taught at UCLA and USC for 30 years, received good feedback from colleague at both schools. Their suggestions have helped Kotler through three generations of the device.

He’s now used the device on 37 patients and is writing a research paper on what he says have been 100 percent positive reactions from patients.

With the FDA application in, and a patent pending since last year, companies are interested in the device, Kotler said, including one that wants to take it worldwide.

Anesthesiologists also love the device, Kotler says. “It gives them a channel into the back of the throat to evacuate blood or mucus that accumulates in the throat. With this system they can use a suction catheter, using the same tube, even while the patient is asleep.

The underlying message, Kotler says, is that there’s a  huge demand  for the operation. “It’s amazing that patients can have a one-time operation and breathe for the rest of their life

“It’s a nuance, but an important one,” Kotler stated.

And there are many people who can be helped, according to Kotler. Anything that blocks the nasal passages, like  a broken nose that wasn’t corrected properly, can contribute to sleep apnea with an estimated 20 million sufferers in the United States.

Another 40 million suffer from allergies. A recent patient, also a doctor, told Kotler he’d cured his allergies.  “Allergies are sensitivity of tissues to everything in the air,” Kotler explained. “When we trim the turbinates and straighten the noes, there is less tissue to swell and less blockage.”

 Kotler is the author of Secrets Of A Beverly Hills Cosmetic Surgeon and its followup, The Essential Cosmetic Surgery Companion. He was also one of the original ensemble members of E! Channel’s Dr. 90210.

—Steve Simmons