VivAer® Patient Information
What is Vivaer?
Vivaer is a minimally invasive, in-office procedure designed to treat nasal obstruction — a common condition that makes it difficult to breathe easily through the nose. Nasal congestion is often caused by a combination of factors, including swelling of the inferior turbinates, structural shifts in the nasal septum and swell bodies, and weakening or narrowing of the nasal valve — the area just inside the nostrils made up of delicate cartilage.
The nasal valve is the narrowest part of the nasal airway and plays a major role in how easily air passes through the nose. In many patients, especially during deep breathing, the suction effect from airflow can cause the cartilage in this area to collapse inward, making the breathing space even narrower and leading to a feeling of congestion — even if the septum or turbinates are not severely enlarged.
Traditionally, treating this required surgical rhinoplasty with cartilage grafting to reinforce the nasal valve. Vivaer offers a non-surgical alternative that reshapes and strengthens the cartilage using controlled, low-temperature radiofrequency energy — without any cuts, grafts, or changes to the appearance of the nose.
By supporting the internal nasal valve and improving its ability to stay open during breathing, Vivaer helps increase airflow, reduce congestion, and lessen reliance on medications or external aids like nasal breathing strips.
In addition to the nasal valve, Vivaer can also be used to address turbinate hypertrophy and other contributors to nasal obstruction during the same visit — making it a versatile and comprehensive solution.
The procedure is performed entirely in the office under local anesthesia. Most patients return to normal daily activities the same day. Vivaer is a safe, convenient, and effective option for those seeking long-term improvement in nasal breathing without surgery.
Preparation and Day of Procedure
There is no special preparation required before your Vivaer procedure. However, if you are currently taking blood thinners or supplements that may affect bleeding, such as aspirin, Plavix, warfarin (Coumadin), Eliquis, fish oil, turmeric, or ginkgo, please notify our office in advance. Dr. Ghiam will coordinate with your primary care provider or specialist if any temporary adjustments are necessary.
The entire visit will take approximately 1.5 hours. When you arrive, we’ll begin by reviewing the details of the procedure, including how Vivaer works, the expected benefits, risks, and the recovery process. You’ll have the opportunity to ask any questions, and a consent form will be reviewed and signed before we begin.
We’ll then begin the numbing process, which takes approximately 30–40 minutes and is designed to keep you completely comfortable throughout. This includes:
- Application of a numbing and decongestant spray to the nasal passages.
- Placement of pledgets — small, medicated cotton strips — which are left in place for 10–15 minutes at a time for full effect.
- This process is typically repeated in several rounds, with each new set of pledgets placed progressively deeper into the nasal passages to numb the internal nasal valve and adjacent areas.
A topical lidocaine cream is then applied to the nasal valve region for additional anesthesia.
- If needed, a small localized injection may be administered to reinforce numbing.
To help with comfort during the procedure, we offer Tylenol (acetaminophen) prior to beginning. You also have the option of taking a low dose of Valium to reduce anxiety and enhance relaxation during the procedure. If you choose to take Valium, it is important that you arrange for someone to drive you home afterward, as you will not be permitted to drive yourself.
The procedure itself takes approximately 20-25 minutes. Using a small, handheld Vivaer device, a total of 24 radiofrequency treatments are delivered as follows:
- The nasal valves typically receive 4–5 treatments per side, with each treatment lasting around 30 seconds to help support and reshape the cartilage.
- The inferior turbinates are then treated with another 4–5 applications, generally 15 seconds each, to reduce obstruction from soft tissue swelling.
- Remaining treatments may be directed toward other contributing structures, such as the swell body, based on your anatomy and breathing pattern.
Once the treatment is complete, we will place additional pledgets in the nose to slow any minor bleeding and help with initial recovery. You’ll then be observed for 10–15 minutes before discharge, and we’ll review your aftercare instructions in detail and answer any final questions.
instructions and answer any final questions.
Please be sure to arrange for someone to drive you home, especially if you choose to take Valium
After Care and Recovery
Bleeding & Discomfort
It is completely normal to experience mild spotting or light bleeding from the nose during the first 24–48 hours after your Vivaer procedure. This is a typical part of recovery following any internal nasal treatment. Using a small piece of gauze under the nostrils (a “nasal dressing”) can help absorb drainage and keep you comfortable throughout the day.
In addition to internal healing, you may also notice mild swelling or tenderness to the touch over the cartilage in the upper part of the nose. This is expected and will gradually resolve over the first 1–2 weeks. Importantly, Vivaer will not alter the appearance of your nose — the swelling is temporary and does not reflect any cosmetic change.
Pain is generally mild and often requires only over-the-counter medication. We recommend:
- Tylenol (Acetaminophen): 1,000 mg every 8 hours as needed
- Ibuprofen (Advil): 400–600 mg every 8 hours as needed
These may be taken together for stronger relief or alternated every 4 hours to maintain continuous pain control throughout the day.
Congestion and Crusting
It is common to experience nasal congestion during the first week after the procedure. This occurs as part of the normal healing response and will begin to improve as the week progresses. You may also notice crusting or dryness near the front part of the nose, especially around the nasal valve area — this is also expected.
In the following section, we will discuss the use of nasal sprays to help relieve congestion and an ointment to soften crusting and support healing in the front of the nose.
Medications & Sprays
- Nasal Saline Rinses (NeilMed)
Start saline rinses the day after your procedure using a squeeze bottle such as NeilMed Sinus Rinse. Rinse 2–4 times per day to flush out mucus, debris, and dried blood. These rinses help keep the nose clean, reduce congestion, and support the healing process. Regular rinsing also helps minimize crusting and improves comfort during recovery.
- Oxymetazoline (Afrin)
Afrin is helpful for both congestion relief and bleeding control during the first week:
- For congestion relief: Use 2–3 sprays per nostril at night to improve breathing and sleep quality.
- For bleeding control: If bleeding feels excessive, use 4 sprays per nostril, then pinch the soft part of your nose and lean forward. Hold for 10 minutes to allow the bleeding to slow.
Afrin can be safely used for up to 7–10 days after the procedure, which is longer than typical over-the-counter recommendations.
- Mupirocin Ointment (Prescription)
Apply a small amount of Mupirocin ointment to the tip of the nose and just inside the nostrils 2–3 times per day for 2 weeks. This helps moisturize the nasal lining, limit crusting, and reduce irritation around the nasal valve area as it heals. A clean cotton swab can be used for gentle application.
Expected Recovery and Benefits Over Time
- Pain and tenderness usually improve significantly within 24–48 hours.
- Congestion is most noticeable during the first week, when swelling and crusting are at their peak. This improves over the second week with continued rinses, occasional Afrin use, and gentle in-office cleaning.
- Crusting and dryness near the front of the nose are normal and typically resolve with the use of saline rinses and Mupirocin ointment.
When Will I Notice the Benefit?
The full benefit of the Vivaer procedure typically becomes noticeable at around 6 weeks, with continued improvement over 4 to 6 months. This is the period during which the nasal cartilage undergoes remodeling, becoming stronger and less prone to collapsing with deep breathing. As this remodeling stabilizes, patients often experience better airflow, improved breathing during sleep and exercise, and reduced need for medications or nasal strips.
Follow-Up
We typically see patients three times after the procedure to support your recovery and monitor your progress:
- 1 Week Post-Procedure
- 2 Weeks Post-Procedure
These first two visits allow Dr. Ghiam to check in on your healing and gently clean the nose, which helps clear out dried mucus and debris, speeding up your recovery.
- 6 Weeks Post-Procedure
At this visit, we will assess your response to treatment, review symptom improvement, and determine whether any further care or adjustment is needed.
Please don’t hesitate to contact us earlier if you have questions, unusual symptoms, or would like to check in between scheduled visits.