BOAS surgery is a set of procedures designed to open the airways of flat-faced dog breeds like Bulldogs, Pugs, and French Bulldogs. These dogs are born with shortened skulls that compress their airways, a condition called Brachycephalic Obstructive Airway Syndrome. The surgery reshapes the soft tissue structures that block airflow, including the nostrils, soft palate, and structures inside the throat. About 81% of dogs show measurable improvement in breathing after the procedure.
What BOAS Actually Fixes
Flat-faced breeds have the same amount of soft tissue as longer-nosed dogs packed into a much smaller space. This creates multiple points of obstruction. The nostrils are often narrowed to slits, making it hard to draw air in. The soft palate, the fleshy flap at the back of the roof of the mouth, is too long and too thick, partially blocking the entrance to the windpipe. Inside the throat, small pouches of tissue called laryngeal saccules get sucked inward by the effort of breathing through such tight spaces, narrowing the airway even further.
BOAS surgery addresses these problems at up to three sites in a single session. Not every dog needs all three corrections. Your veterinarian or surgeon will evaluate which structures are contributing most to the obstruction and tailor the procedure accordingly.
The Three Core Procedures
Nostril Widening (Rhinoplasty)
The surgeon removes a wedge-shaped piece of tissue from each nostril, then stitches the edges together so the nostril opening is pulled wider. This is the most straightforward part of the surgery and can sometimes be done on its own for milder cases. Some dogs also have a second area of narrowing just behind the nostril opening, in the nasal vestibule. In those cases, an additional strip of tissue inside the nose (the alar fold) is removed to clear that deeper obstruction.
Soft Palate Shortening (Staphylectomy)
The elongated soft palate is trimmed back to the tip of the epiglottis, the small cartilage flap that protects the windpipe during swallowing. If the palate is abnormally thick, surgeons may use a technique called folded flap palatoplasty, which both shortens and thins the tissue. This is the part of the surgery most responsible for reducing snoring, gagging, and the characteristic loud breathing these breeds are known for.
Laryngeal Saccule Removal (Sacculectomy)
The everted saccules, small pouches of tissue that have been pulled into the airway by years of labored breathing, are snipped out with fine instruments. This opens the lower part of the larynx. The complication rate for this particular step is very low, according to the University of Cambridge veterinary team.
Laser vs. Traditional Scalpel
Surgeons can perform soft palate work with either a traditional blade or a CO2 laser. The laser vaporizes tissue precisely while sealing blood vessels smaller than half a millimeter, which means less bleeding during surgery and less swelling afterward. In studies comparing the two approaches, laser surgery resulted in shorter operating times, faster healing, and lower pain scores. Dogs operated on with a laser ate their first meal about 8 hours after surgery on average, compared to 12 hours for dogs treated with a scalpel.
The laser also causes less inflammation, which matters in a part of the body where even minor swelling can compromise the airway. Not every veterinary practice has a surgical CO2 laser, so availability may vary depending on your location.
When Advanced Surgery Is Needed
Some dogs, particularly Pugs and French Bulldogs, have excess tissue inside the nasal passages themselves (the turbinates) that continues to block airflow even after the standard procedures. If a dog’s breathing doesn’t improve enough after conventional multi-site surgery, a procedure called laser-assisted turbinectomy (LATE) may be recommended.
CT imaging can predict which dogs will need this additional step. In Pugs, those with soft tissue filling more than 64% of the nasal passage opening are likely candidates. For French Bulldogs, the threshold is about 55%. Dogs that underwent turbinectomy after inadequate improvement from standard surgery saw their breathing obstruction index drop from 67% to 42%, a significant gain.
Success Rates and What to Expect
In a study tracking 32 dogs through both short-term and long-term follow-up, 81.3% showed improved breathing scores after surgery. Nearly half improved by one functional grade, and about a third improved by two full grades. Long-term BOAS index scores dropped by a median of 22.9 percentage points. Among the dogs studied, none worsened more than marginally, with only one dog out of 16 showing any decline at long-term follow-up.
Owner perception tells a slightly different story. About 55% of owners believed their dogs no longer had breathing problems after surgery, while 39% felt some breathing issues remained. Interestingly, the measured breathing scores between these two groups were nearly identical, suggesting that some residual noise or effort is normal even after a successful surgery. The goal is substantial improvement, not necessarily silent breathing.
Risks and Complications
The most critical risk period is the first 24 hours after surgery, when airway swelling can temporarily make breathing harder before it gets better. In a study of 199 dogs undergoing BOAS surgery, the complication rates broke down as follows:
- Low blood oxygen levels: 5% of dogs
- Breathing difficulty requiring the breathing tube to be reinserted: 7%
- Breathing difficulty requiring a temporary tracheostomy: 5%
- Aspiration pneumonia (food or fluid entering the lungs): 6%
Dogs that need a temporary tracheostomy typically have it in place for 2 to 3 days while swelling subsides. These complications are why most surgeons keep BOAS patients hospitalized for at least 24 hours after the procedure, with close airway monitoring.
Recovery at Home
After discharge, recovery requires about two weeks of careful management. Dogs that had soft palate surgery should eat only soft food, formed into small meatballs, for the first two weeks to avoid irritating the healing tissue. Dogs that had nostril surgery need to wear a cone (Elizabethan collar) to prevent pawing at the incisions. Mild sedation medication is commonly prescribed for 10 to 14 days to keep dogs calm during healing.
Most dogs are noticeably breathing better within a few days, though full healing of the surgical sites takes longer. The soft palate in particular needs time to settle, and some swelling-related noise in the first week or two is expected.
How Much BOAS Surgery Costs
In the United States, full corrective BOAS surgery typically runs between $3,000 and $5,000. The core surgical fee for Bulldogs and Pugs usually falls between $2,500 and $3,500, with pre-operative bloodwork and consultation adding around $100 or more. Dogs needing fewer corrections or treated at smaller clinics may pay $1,000 to $3,000, and nostril-only correction can start as low as $800.
Complex cases requiring advanced techniques or extended hospitalization can reach close to $4,900. Some owners choose to combine BOAS surgery with spaying or neutering, which adds $350 to $500 but avoids putting the dog under anesthesia a second time. Costs vary significantly by region and whether you’re seeing a board-certified surgeon or a general practitioner with airway surgery experience.