Brachycephalic Airway Surgery (BOAS) for Dogs in Los Angeles

What is brachycephalic obstructive airway syndrome (BOAS)?

BOAS is a chronic breathing disorder caused by the flattened head shape of brachycephalic dogs. Generations of breeding for a short muzzle shortened the bones of the face without shrinking the soft tissue inside, so structures like the soft palate, nostrils and nasal passages are effectively “too big” for the space available. The result is increased resistance to airflow — the dog has to work harder to move air with every breath. It usually involves several problems at once rather than a single defect, which is why a thorough airway evaluation matters. Around 1 in 5 brachycephalic dogs is seen by a primary-care vet for an upper-airway problem at some point, and many more go undiagnosed because their owners assume noisy breathing is normal.

Which breeds are affected, and why?

The breeds most affected are French Bulldogs, English Bulldogs and Pugs, with Boston Terriers, Boxers, Shih Tzus, Cavalier King Charles Spaniels and other short-nosed dogs also at risk. Their popularity has risen sharply over the past two decades, and so has the number of dogs living with airway disease. Severity varies by breed and by individual: French Bulldogs tend to have thicker soft palates, while Pugs often have the smallest relative nasal airway and are particularly prone to advanced changes such as laryngeal collapse. Importantly, a dog can look “fine” to its family and still be significantly affected — which is why objective assessment is so valuable. French Bulldog family? See our decision guide on whether your French Bulldog needs BOAS surgery.

What are the signs of BOAS in my dog?

The most common signs are noisy breathing or loud snoring, snorting, getting tired or out of breath quickly, struggling in heat, and disrupted or restless sleep (some dogs wake themselves up or sleep sitting up). Many flat-faced dogs also have digestive signs — gagging, retching, bringing up food or foam, or vomiting — which often worsen with excitement or exercise. In more severe cases, dogs may show a bluish tongue or gums (cyanosis), or collapse, especially when hot or stressed. Because these signs creep in gradually, families frequently mistake them for the dog's “personality” or breed. If your dog shows any of these, an evaluation is worthwhile — these are exactly the patterns a focused airway exam is designed to catch.

What problems happen inside the airway?

BOAS is usually a stack of overlapping problems. The main primary ones a dog is often born with include:

• Stenotic (pinched) nostrils — narrowed nasal openings that dramatically increase the effort to breathe in; moderate-to-severe narrowing can raise airflow resistance many times over.
• An elongated and thickened soft palate — the most common finding (present in up to ~87% of affected dogs), where excess tissue at the back of the mouth partly blocks the airway.
• Aberrant nasal turbinates — extra scroll-like tissue crowding the nasal passages.
• A narrowed (hypoplastic) windpipe and, in some dogs, an enlarged tongue that further crowds the throat.

Over time, the constant extra effort can cause secondary changes, including everted laryngeal saccules, everted tonsils, and laryngeal or tracheal collapse — where the voice box or windpipe weakens and begins to give way. Secondary collapse is harder to treat, which is one reason earlier evaluation is preferred: relieving the primary problems sooner may help limit how far these secondary changes progress.

How is BOAS diagnosed?

Diagnosis often starts simply: history, a physical exam, and a look at the nostrils, which can be graded from open to severely pinched. A practical, validated tool is an exercise-tolerance (“trot”) test — listening to the dog's breathing before and right after a short, brisk three-minute walk — which sharply increases the accuracy of diagnosis. From there, imaging such as CT can map the soft palate, nasal turbinates and chest in detail and screen for complications like aspiration pneumonia, while endoscopy lets the surgeon see the larynx and windpipe directly and check for laryngeal collapse or related digestive issues. Not every dog needs every test; Dr. Pedraza recommends only what's useful for that individual patient and surgical plan.

How is BOAS treated?

Treatment has two halves: everyday management and surgery to widen the airway.

Management matters for every patient. Keeping a lean body weight is essential — extra weight measurably worsens BOAS — along with avoiding heat and over-exertion, using a harness instead of a neck collar, and managing any digestive signs.

Surgery aims to create more room to breathe by correcting the structures that crowd the airway. Depending on the dog, that may include:

• Widening the nostrils (rhinoplasty / alaroplasty) to reduce resistance at the very front of the airway.
• Shortening and thinning the soft palate (staphylectomy, or a folding-flap palatoplasty that also reduces thickness) to open the throat.
• Removing everted laryngeal saccules or tonsils when they are obstructing airflow.
• Addressing laryngeal collapse in advanced cases — a more complex situation reserved for dogs that don't respond to the steps above, sometimes including specialized techniques or, as a last resort, a permanent tracheostomy.
• Laser reduction of aberrant nasal turbinates in selected dogs that remain obstructed after standard surgery.

These procedures are frequently combined in a single, carefully planned “multilevel” surgery, because most dogs have more than one problem.

Why minimally invasive, laser-assisted airway surgery?

Airway surgery in flat-faced dogs benefits from precision and gentle handling of delicate, swelling-prone tissue. Using CO₂ laser and advanced energy (vessel-sealing) devices for procedures like soft-palate surgery can reduce bleeding and shorten surgical time compared with traditional cutting and suturing, while high-definition visualization helps the surgeon work accurately in a small, tight space. Less bleeding and less tissue trauma can mean a smoother early recovery — though, as with any surgery, results depend on the individual dog and the severity of disease. Dr. Pedraza selects the technique and instruments to fit each patient's anatomy and goals. This builds on our wider experience with laser & energy procedures and veterinary endoscopy.

Does my dog need surgery — and when?

Not every brachycephalic dog needs an operation, but dogs with meaningful signs usually benefit from evaluation sooner rather than later. The reasoning is simple: BOAS tends to be progressive, and the constant strain of obstructed breathing can drive secondary changes such as laryngeal collapse that are far harder to fix. Addressing the airway earlier — often while a dog is young — gives the best chance to relieve the primary problems before that damage accumulates. The right answer for your dog comes from an individual assessment of which structures are involved and how severely.

What is recovery like, and what results can we expect?

Most airway-surgery patients are monitored closely on the day of surgery and go home with a written care plan; the early recovery period typically spans one to two weeks, with activity, heat and food managed carefully while swelling settles. Owners commonly report clear improvement in breathing, energy and sleep after surgery — in many studies, the large majority of families see their dog do better. It's important to be candid, though: surgery improves the airway rather than making a flat-faced dog's anatomy normal, and some dogs remain partially affected even after a good operation. Lifelong weight control and sensible heat/exercise management remain part of the picture. Dr. Pedraza will discuss realistic expectations for your dog before any procedure. Learn more about Dr. Pedraza or contact our Santa Monica clinic.