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Can Depressions Below Nasal Bones Be Fixed During a Revision Rhinoplasty?

asked 1 year ago by 11704 in Lindenhurst
Latest answer by Daniel Reichner, MD
Question viewed 444 times
Tags: cartilage, depression, graft, nasal bone, options, spreader

During septorhinoplasty the doctor changed the size and position of my nasal bones. The bones are shorter. Now,in addition to nasal valve collapse,the upper lateral cartilages now do not touch the bones and I have a depression on each side just below the nasal bones where the missing bone once was.

In addition to spreader grafts to fix the mid vault collapse, is it possible to add something in the area where there is no lateral cartilage to fix the depressions?

13 answers to Can Depressions Below Nasal Bones Be Fixed During a Revision Rhinoplasty?

+1

Spreader grafts after Rhinoplasty

 It sounds like you have an open roof deformity and over resection of the upper lateral cartilages.  There are a couple of choices based on the height of the remianing nasal bones.  If the bones have enough vertical height, a lateral osteotomy can bring them back together in the midline.  If they are to short to meet in the midline, an onlay implant (I prefer solid silastic dorsal implants for this purpose) can cover the entire area....which would include and also close... more
Francis R. Palmer, III, MD

Beverly Hills Facial Plastic Surgeon

drfrancispalmer.com

+1

Inverted V Deformity

The "inverted V" deformity is a dislocation and inward collapse of the upper lateral cartilage with loss of adherence to the caudal nasal bones. This problem is commonly seen with large hump removal, short nasal bones and lateral osteotomies. Spreader grafts can correct the mid-vault collapse and improve breathing, but may not always correct the cosmetic inverted-V deformity. For these residual cosmetic deformities, consult an experienced plastic surgeon... more
Daniel Reichner, MD

Newport Beach Plastic Surgeon
+1

Correcting depressions during a revision rhinoplasty

Depressions below the nasal bones are usually best addressed with spreader grafts placed underneath the upper lateral cartilages to correct the degree of concavity to more convex. This improves the airflow dynamics through the nose as well as the outward appearance and gives more width to the mid third of the nose. If spreader grafts are not enough, occasionally a double or triple spreader graft can be placed when needed. If this still does not address the concavity issues,... more
William Portuese, MD

Seattle Facial Plastic Surgeon

www.seattlefacial.com

+1

Depressions after rhinoplasty surgery may be corrected with surgery or fillers

Depressions after rhinoplasty between the bones and cartilages can be a difficult problem. I absolutely agree that spreader grafts may be helpful in treating what is called, "an inverted V" deformity. This involves harvesting cartilage from your septum or ears and supporting the collapsed areas. This may help with the cosmetic appearance and if your collapse is decreasing your breathing, it may help with the breathing also. Another excellent option is... more
David Mabrie, MD

Bay Area Facial Plastic Surgeon

yourfaceinourhands.com

+1

Mid-vault collapse from Rhinoplasty

The use of fillers in this area is controversial at best. You would be risking asymmetry, nodularity, and even skin loss. Surgical correction of the deformity you describe classically consists of spreader graft placement. This acts to reposition upper lateral cartilages and eliminate the depression below nasal bones. In addition, an overlying soft tissue graft would be of benefit to further prevent and camouflage irregularities. Grigoriy Mashkevich, MD New York Facial Plastic Surgeon. more
Grigoriy Mashkevich, MD

Manhattan Facial Plastic Surgeon
+1

Inverted V Deformity after Rhinoplasty

The inverted V deformity you describe is usually corrected with spreader grafts and repositioning the nasal bones with osteotomies if there is an open roof deformity. Your revision surgeon will decide what is necessary.
Richard W. Fleming, MD

Beverly Hills Facial Plastic Surgeon
+1

Middle vault collapse

It's hard to tell without seeing your pictures but you likely need spreader grafts, possibly redo of the osteotomies, and possibly could benefit from onlay contour grafts. 
Sam Naficy, MD

Seattle Facial Plastic Surgeon

seattleface.com

+1

Can Depressions Below Nasal Bones Be Fixed During a Revision Rhinoplasty?

A picture would help rather than we guess what the problem is. However, the depression below nasal bone on both sides usually is due to collapse of upper lateral cartilages also known as inverted V deformity. You may also describe incomplete fracture of the nasal bones causing open roof deformity. The latter can be corrected with spreader graft or upper lateral cartilages elevation with sutures to reconstruct the dorsum. The open roof deformity requires osteotomy.
Mohsen Tavoussi, MD, DO

Huntington Beach Facial Plastic Surgeon
+1

Middle nasal vault collapse

It sounds like your upper lateral cartilage may have become disinserted from your nasal bones. Reconstructing the area with cartilage spreader grafts can help with both the depression and narrowing you see in the area.
Thomas A Lamperti, MD

Seattle Facial Plastic Surgeon

www.drlamperti.com

+1

Rhinoplasty midvault collapse

Correcting mid-vault collapse often can be accomplished with spreader grafts.  I would personally avoid injectable silicone because it has been frought with complications such as palpability, inflammation, infection, and an inability to remove it.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Cartilage spreader grafts may be fashioned to improve indentations by your nasal bones.

I read your concern. If you have collapse of your upper lateral cartilages that would require spreader grafts to repair, your surgeon can fashion an extended spreader graft to fill the entire indentation in the bridge of your nose. If your breathing is satisfactory, you may consider a non-surgical rhinoplasty to fill the indentations with topical anesthetic and no downtime. My personal preference is to use Silikon-1000, an off-label filler for permanent results. Regards from NJ. more
Eric M. Joseph, MD

West Orange Facial Plastic Surgeon
+1

Rhinoplasty

You are describing seperation of the upper lateral cartilage from the bone. This seperation causes a depression at the junction of the upper lateral cartilage and the bone. It will also cause collapse of the nasal valve. Correction will require a spreader graft to support your valve and may need another graft for correction of upper lateral cartilage seperation.
Samir Shureih, MD

Baltimore Plastic Surgeon
+1

Can Depressions Below Nasal Bones Be Fixed During a Revision Rhinoplasty

Dear 11704: It would be helpful to know when your surgery was performed. It sounds from your description that you may have what is called an open roof deformity, where the bones are too wide and do not meet in the midline, creating a palpable space where the bones are sitting. This can be treated by narrowing the bones with osteotomies, re-cuting the bone. Also, cartilage may be needed to be placed where the space is. I recommend you follow up with your surgeon, or consult with a... more
Michel Siegel, MD

Houston Facial Plastic Surgeon

houstonfaces.com

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