Do I have an Inverted V deformity? (photo)

Question

Several docs mentioned that I look to have an Inverted V deformity. I emailed my surgeon & his response was "not possible for you to get an inverted v deformity because the upper lateral cartilages are firmly attached to the nasal bones, I did not cut them but rasped them." I moved away after my surgery & have not seen him since the 3month mark - it's been a year now & Im still not happy. What is your opinion? If it is an IVD would you go back to original surgeon to correct or find new doctor?

Toby Mayer, MD · Answer

Inverted V deformity? Yes! I would go back to your surgeon IF you have confidence in him. If not see a very experienced revision rhinoplasty surgeon with good before after photos of his work--not imaging or diagrams.

Garrett A. Wirth, MD, MS, FACS · Answer

It is not obvious, but there are characteristics of the inverted V.  Since you are so far out from your surgery, it is safer now to re-operate, if that is your desire.  Keep in mind that there are some other temporary (such as fillers) and more permanent (such as fat) injections that could assist in contouring if it still bothers you.Garrett A. Wirth, MD, MS, FACSWirth Plastic Surgery

Garrett H. Bennett, MD · Answer

You do have a mild inverted V deformity. Rasping a bump can detach upper lateral cartilages and cause this. You also appear to have wide nasal bones above your cartilage. The nasal bones should have been narrowed with osteotomies after the bump was taken down. Osteotomies can be performed by your original or new surgeon. Evaluation may show that internal spreader grafts would help but it is tough to tell by photo alone.

Steven Wallach, MD · Answer

It does look like you have an inverted v deformity in the photos. Often spreader grafts can help to improve this as one maneuver.

Michael Sundine, MD, FACS · Answer

In reviewing your photographs it does appear that you have an inverted V deformity.  You will need a revision rhinoplasty to address the deformity or you may be able to camouflage the deformity with some filler.  I would recommend you follow up with your surgeon to let them examine you more closely.

William Portuese, MD · Answer

The inverted V. deformity  his usually the result of a discontinuity between the nasal bones and the upper lateral cartilages. This is usually created when the attachment to the upper lateral cartilages to the septum has been transected when there has been a hump removal. Sometimes, it takes many years for the inverted V. deformity to present itself. The treatment for the inverted V. is a combination of osteotomies and spreader graft placement underneath the concave upper lateral cartilage. For many examples and more information about spreader grafts, please see the link below

David Reinstadler, MD · Answer

An 'inverted v' deformity is a clinical description of changes to the underlying structure. It can result from a few things. Your surgeon mentioned that he did not alter the relationship with the upper lateral cartilages and the nasal bones, which may be totally correct. This can result from the upper lateral cartilages not being secured to the septum as well. It can also result from the upper lateral cartilages dropping down below the top of the septum. I would recommend an in-person consultation with a revision rhinoplasty surgeon who can evaluate your specific case and offer suggestions. The most permanent way to address this issue is to securely attach spreader grafts to bridge the discrepancy between the septum and upper lateral cartilages. Best of luck

Steven J. Smith, MD · Answer

The lower two thirds of your nose appear straight from the frontal view with an offset of the upper bony pyramid.  I have found Juvederm and Restylane injections to be very effective at camouflaging these minor discrepancies. The hyaluronic fillers seem to have good longevity in the nose and repeated injections last longer each time they are performed due to a "layering" effect.Reoperation for the apparent defects shown in the pictures would be a significant procedure and there may still be some irregularities.

Darryl J. Blinski, MD · Answer

Appears as a very acceptable result. But if you are fixed upon this issue I might offer low dose of HA fillers to effectively treat...

Heather J. Furnas, MD · Answer

It is difficult to tell from photographs. There is a slight shadow, but a physical examination would yield a more accurate assessment.You mentioned "several docs." Have you gotten a formal second opinion? If not, consult with a board-certified plastic surgeon or facial plastic surgeon. He/she can examine you and make the determination.

Do I have an Inverted V deformity? (photo)

Answers (10)

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