Collapsed External Valves Breathing In, Do I Have Open Roof Deformity?

Septorhinoplasty done in March 2011. Seems to me that i have a deformity in the bridge and a hump(pollybeak?)or supratip which causes the tip to go downward (tip ptosis?).Do i have an inverted V or open roof deformity? Also it looks like my tip was too pinched and ULCS and LLCS overresected causing external valve collapse(please see pictures).I also have the impression that there's a slight septum deviation to my right side.Oppinions are welcomed.

Doctor Answers 4

Malposition of the alar cartilages in rhinoplasty.

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Malposition of the alar cartilages in rhinoplasty is an anatomical variant some patients have. If an alar graft is not used they get "pinching" of the tip. Furthermore, when the bridge is reduced one has to have spreader graft placement ot keep the mid airway open.

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

You appear to have a nice cosmetic result after Rhinoplasty Surgery.

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I read your concerns and reviewed your photos:

The 2 photos on the left demonstrate nostril-collapse with inhalation. Many patients that never had rhinoplasty surgery are able to collapse their nostrils with maximum effort. You're collapsing your nostrils, but it is not clear how hard you're inhaling. If you're having chronic nasal obstruction you may want to consult a qualified ENT to discuss your treatment options.

You do not appear to have an open-roof deformity, poly-beak deformity, or a pinched tip. You appear to have an acceptable cosmetic result.

I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Collapsed External Valves Breathing In, Do I Have Open Roof Deformity?

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Thanks for the photos showing internal valve collapse. As for an open roof deformity it is a maybe. Best to seek in person evaluations from expert rhinoplasty surgeons. 

External valves require cartilage support

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The external valves--essentially the skin along the lower nasal third and the nostril rims--need support or the nostrils collapse like yours do..  All of your problems have been caused by resection--of the dorsum and tip cartilages.

You also have a normal anatomical variant--malposition of the alar cartilages--that complicates the problem.  Your airway is probably 25% of what it was, according to my published research in 600 patients.

Cartilage grafts to your bridge and tip will help you.  Find an experienced surgeon whom you like and who can demonstrate correction of the same problems in other patients. Your self-diagnosis is accurate so you should be able to find a good surgeon because you understand the problem.

Mark B. Constantian, MD, FACS
Nashua 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.