Rhinoplasty Q&A

80%

WORTH IT RATING

1,002 Reviews

Ask a Question

View Before and Afters

Average Rhinoplasty Cost: $5,975

Learn about Rhinoplasty

5,047 people and 803 doctors are talking about Rhinoplasty

Get Free Email Updates

Middle Vault Collapse After Rhinoplasty

asked 3 years ago by Gabriela in Bucharest
Latest answer by William Portuese, MD
Question viewed 2,459 times
Tags: nose, dorsal hump, deviated septum

I have had Rhinoplasty eight months ago for deviated septum and removal of a hump. Is a closed Rhinoplasty more prone to middle vault collapse than an open Rhinoplasty? I am worried about that condition. It is easily recognizable by that inverted V.

Read my review "8 Months After Rhinoplasty Still Think of It As WORTH IT."

13 answers to Middle Vault Collapse After Rhinoplasty

Middle vault collapse can occur from either type of rhinoplasty.

Open and closed rhinoplasty can both create an inverted-V deformity and collapse of the middle vault. It is a direct result of what is done to the upper level cartilages and it is not reflective of the open or closed technique. The middle vault collapse can occur from either type of rhinoplasty.

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Great question, now what to do?

I don't know which technique is more prone to this problem, but you describe the problem. The inverted V is cosmetic, but you may also be at risk from functional (breathing) problems too. The problem can be corrected by cartilage overlay grafting- I recommend open technique for this. You should wait until you heal a bit more. In the mean time, you can camo the defect with fillers such as Radiesse. sek

Scott E. Kasden, MD
Dallas Plastic Surgeon

Middle vault collapse is not dependent on technique

When a surgeon perform a rhinoplasty, there is a component of artistry to the procedure, as well as an "educated guess" as to how the random nature of scar contracture, healing, and skin memory will play into the final result after all of the healing and edema has resolved. That being said, the final result is more dependent on you surgeon's familiarity with the possible outcomes based on inter-operative findings. I perform both open and closed rhinoplasty, and will choose the... more

Michael A. Bogdan, MD
Dallas Plastic Surgeon

Middle Vault collapse not due to surgical approach

The middle vault collapse you speak of does not happen more or less frequently with external or internal rhinoplasty but is usually due to other factors some technical and some not.

Richard Gentile, MD
Cleveland Facial Plastic Surgeon

www.facialplastics.org

Can happen with open or closed rhinoplasty.

Middle vault collapse can happen with either open or closed rhinoplasty if the middle vault is not supported. Return to your surgeon and see what he thinks. This will be cheaper (if you have confidence in him) than another surgeon revising this. But if you are unsure, see an experienced revision rhinoplasty specialist for a second opinion.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon

Middle vault problems can occur with either Rhinoplasty technique

Some of the conditions that make this more likely are mentioned in the previous responses, but don't forget that thin skin does not help hide the underlying structural components either. If there is a problem, then one needs to determine if it is functional or purely aesthetic.I don't believe that placement of grafts between the upper lateral cartilages and septum should be a routine treatment. There can be problems with this also. Sometimes other techniques are used that are better than... more

Phillip Langsdon, MD
Germantown Facial Plastic Surgeon

Revision Rhinoplasty: Correcting an "Inverted-V" Deformity

A rhinoplasty in which the bridge is modified can lead to mid-vault collapse overtime if the cartilaginous framework is not supported. This can happen in either an open or closed rhinoplasty. Externally, the collapsed sides of the middle portion of the bridge create the appearance of an "inverted-v" on the exterior of the nose. The treatment (or prevention) of an inverted-v deformity is to support the middle portion of the bridge with spreader grafts widen the bridge and supprt... more

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon

www.rhinoplasty-usa.com

Middle Vault Collapse After Rhinoplasty

You certainly raised an important question that is commonly discussed during rhinoplasty symposia. Although independent from technique, I have seen collapse of the middle vault happening to very experienced rhinoplasty specialists using open and closed approaches. Although a rare surgeon may place spreader grafts prophylactically during every primary rhinoplasty with hump removal, such an approach is rather dogmatic. It is the patient with relatively short nasal bones that is at higher... more

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon

www.drfechner.com

Middle vault collapse is treated with spreader grafts.

Hi. It does sound like you have it. Middle vault collapse is not more likely with closed rhinoplasty, and in New York City we do a lot of closed rhinoplasties. In my opinion, open rhinoplasty is done too often, and it is not necessary. But the correction of middle vault collapse with spreader grafts (cartilage) should be done with the open rhinoplasty technique. Your problem can really be improved.

George J. Beraka, MD
Manhattan Plastic Surgeon

Middle vault collapse not necessarily realted to open or closed approach.

Middle vault collapse is related to both srugical technique as well as the post operative changes that occur as a result of scarring. Although certain maneuvers performed during surgery, may result in a higher incidence of development of the condition, it is not inevitable nor is it completely preventable. Generally the use of technqiues that support and bolster the upper lateral cartilages a and minimize scarring are associated with a lower incidence of middle vault collapse. Some of these... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Rhinoplasty and Middle Vault Collapse

Hi Gabriela, Middle vault collapse is not more common with closed verus open rhinoplasty. It has more to do with how the anatomy of the middle vault is treated during surgery. The structural support of the middle vault needs to be respected by the rhinoplastic surgeon. The support may be violated through either the open or closed approach. Speak to your rhinoplasty surgeon regarding your concerns. Be well. Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon

Bad nose job and over-resection

Middle vault collapse can be caused by loss of structural bony integrity of the nose and more commonly by over-resection of the upper lateral cartilages. The buttress of the lateral nasal sidewalls are lost and thus middle vault anatomy is destroyed. Repair of these nasal deformities requires structured thinking and a meticulous attention to detail. I regularly perform nasal reconstruction using an open technique to visualize and rebuild the nose.

Raffy Karamanoukian, MD
Los Angeles Plastic Surgeon

You are correct

You are correct that it is more difficult to correct an inverted-V deformity with an endonasal or closed approach. I almost 95% of the time place spreader grafts which help prevent middle vault collapse after rhinoplasty after reducing a dorsal hump. If you do not do this you run a significant risk of breathing problems years later with scar contracture. Unfortunately, I have had to revise many rhinoplasties done enodnasally without placement of spreader grafts. I wish you the best of luck. more