Middle Vault Collapse After Rhinoplasty

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.

Doctor Answers 13

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.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

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.


Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.8 out of 5 stars 106 reviews

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 technique that I feel will best allow me to achieve the desired result. The open technique is definitely more powerful and allows the surgeon to manipulate many more aspects of the nose directly. Spreader grafts can be placed by both techniques, but they are technically easier when performed open. When I've made the decision to perform an open rhinoplasty, it is because I feel I need to perform more extensive structural remodeling of the nose, and thus it is more likely that I'll be performing spreader grafts than if I had decided to proceed with a closed approach. The fact that your surgeon decided to proceed closed probably means he/she did not feel extensive work was necessary (if they have the same mental algorithms as I do). Wait till all of the edema and healing has completed (at least a year after surgery) before making any final judgments as to the results, and then decide how to proceed.

Best regards,

Dr. B

Michael A. Bogdan, MD, FACS
Dallas Plastic Surgeon
4.9 out of 5 stars 67 reviews

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 D. Gentile, MD
Youngstown Facial Plastic Surgeon
4.4 out of 5 stars 36 reviews

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
4.8 out of 5 stars 34 reviews

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 spreaders. Post a photo and let's see what is going on here.

Phillip Langsdon, MD
Germantown Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

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 the middle vault.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 147 reviews

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 risk for collapse of the upper lateral cartilages after rhinoplasty. Therefore, preoperative planning, intraoperative evaluation and the surgeon's experience all contribute to the decision making. In addition, delicate handling of the tissues and utmost respect for nasal anatomy and support are very important to reduce risks for nasal sidewall collapse.

Spreader grafts represent the mainstay of treatment for inverted V and middle vault collapse. These cartilage grafts can be placed both endonasally or through and open rhinoplasty. Although many surgeons may do this only open, that does not mean that this is necessarily better...

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 49 reviews

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 (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

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 maneuvers are easier to perform via an open approach anc therefore this may be less likely to occur. However, these same interventions can be performed through a closed approach as well. Therefore it is not necessarily true that the risk for middle vault collapse is any lower with the open approach.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

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.