Inverted V at 4 months? (photos)

So I'm 4 months post op, and it feels like it's getting worse by the day. My surgeon saw me 2 days ago and claims not to see any problems. I held out hope that it was swelling but it looks like an inverted V. This was a rasping of the dorsal hump, no osteotomy, and some tip work. If it is indeed an inverted V, what is the soonest I can get it fixed? Is there any chance it's just swelling and will improve? It is worse on certain days and in certain lighting.

Doctor Answers 8

Inverted "V"

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It looks like you may have an inverted "V". You need to wait a full year before considering a revision because of soft tissue swelling and pliability issue if one goes back in too soon.

The nose heals for a year or more following rhinoplasty

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There is a shadow in the middle vault that may be an inverted V. This is treatable but I prefer waiting a full year before addressing surgically. The nose is going to continue to heal. Also there is scar tissue under the skin after any surgery that softens for a full year. Going back in too soon could compromise the eventual result.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 134 reviews

During Rhinoplasty, rasping of a dorsal hump without osteotomies may lead to an open roof deformity.

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The center of the nose collapses, both inhibiting breathing and making the nasal bones visible to the naked eye in the shape of an inverted "V." Breathing may also be restricted when the removal of a bump leads to collapse of the internal nasal valve.

Based on your limited photos, it's not clear what might be best for you. Consider re-asking your query with modesty photos in the frontal, oblique, and profile views. Or consider consulting with another rhinoplasty specialist for a second opinion.

Hope this helps you.

Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 429 reviews

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Inverted V deformity

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Inverted V deformity is often from inadequate support of the upper lateral cartilages to the remaining framework of the nose. It really depends on how the upper lateral cartilages were managed and how the nasal dorsum was closed if there was an open roof deformity, either with cartilage grafts or osteotomies.  An examination with a board certified plastic surgeon can help answer this question. Best of luck, MMT

Inverted V Deformity?

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Thanks for your post. You said that you did not have osteotomies of the nasal bones, which can leave you with a shadow, or inverted V mismatch from the nasal bones not moving closer to the midline. However, this mismatch may also be related to narrowness of the upper lateral cartilages in the middle vault area, since you apparently did not have spreader grafts either. In any case, your concerns are reasonable and appropriate. 

You have posted many concerns about your result thus far, and although you are still very early in your recovery and somewhat swollen, you may need to consider a minor revision procedure at some point to address these concerns. Most often it may be best to heal at least one year from your original surgery if you desire a comprehensive  revision rhinoplasty. However, if you are focused on the inverted v issue only, your surgeon may be able to offer you some improvement by performing osteotomies in surgery after waiting another 2 months. Professional and patient communication with your surgeon is best and should lead you to an appropriate solution. Good luck. 

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon

Inverted V

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There is a slight inverted V. However you should wait 6 to 8 months to contemplate a revision. There seems to still be swelling in the tip as well.



Wait a year

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Wait at least a year before considering revision rhinoplasty. Many small details may work themselves out by then and most of the swelling will have resolved.


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Hello and thank you for your question. It is very normal to be swollen still at 4 months postoperative. The dorsal aspect of the bridge of the nose will usually decrease earlier than the nasal tip swelling. Nasal tip swelling can sometimes take 6-12 months to fully resolve. I advise patients that the final result of rhinoplasty takes 12 months.  However, if you do have major contour defect at this time, you may need an evaluation.  It is difficult to tell what is truly going on in this picture.  If you trust your surgeon, then no need to worry.  If you feel like you need a second opinion, then you should seek consultation with a qualified board-certified plastic surgeon.

Best wishes and good luck

Richard G. Reish, M.D.
Harvard-trained Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.