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

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?

Doctor Answers 13

Inverted V Deformity

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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 about carefully placing fascia, crushed/diced cartilage, or off-the-shelf soft tissue filler into the depression.

Newport Beach Plastic Surgeon
4.9 out of 5 stars 50 reviews

Correcting depressions during a revision rhinoplasty

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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, an onlay graft cartilage can also be performed in the area of depression on the upper lateral cartilage.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Depressions after rhinoplasty surgery may be corrected with surgery or fillers

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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 using dermafillers for a non-surgical rhinoplasty technique.  I find that often I am able to exhibit finer control treating indentations and contouring the nose with fillers than during a surgical procedure which is very good at large changes.

Most importantly when considering revision rhinoplasty, have good communication with the initial surgeon.  If you still feel the need for a second opinion, look for a surgeon who has a lot of experience with primary and revision rhinoplasties.

Good luck in your search for information!

David C. Mabrie, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 156 reviews

Mid-vault collapse from Rhinoplasty

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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. 

Grigoriy Mashkevich, MD
Manhattan Facial Plastic Surgeon
4.7 out of 5 stars 10 reviews

Inverted V Deformity after Rhinoplasty

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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
4.9 out of 5 stars 43 reviews

Spreader grafts after Rhinoplasty

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 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 the space between the upper lateral cartilages.  I have placed permanent stitches to sew the upper lateral cartilages together closing similar defects, in the past, with good results.

IMHO, i'd have a few consults and opinions about need for and use of spreader grafts, since they are IMHO often over used and create a larger, wider nose.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Middle vault collapse

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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, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

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

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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
Orange County Facial Plastic Surgeon

Middle nasal vault collapse

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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
4.9 out of 5 stars 22 reviews

Rhinoplasty midvault collapse

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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
New York Plastic Surgeon
4.2 out of 5 stars 30 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.