Expert opinions needed: do I have middle vault collapse/inverted v deformity? (Photos)

From the photos it does appear that you have an inverted V. That by itself can be pretty easy to correct, but I would never call any revision rhinoplasty easy.  The septum appears crooked to the right and the tip cartilages asymmetric. It is important to find a rhinoplasty surgeon that performs a lot of revision rhinoplasty procedures for consultation, but both the appearance and breathing can be fixed at one time.

Hello, thank you for provding photos and question, based on them it seems that you have an inverted v deformity because   collapse of your internal nasal valve and disruption of dorsal aesthetic lines and   a septal deviation that  restricting your right airway. By a well-executed Revision Rhinoplasy can improve your result both cosmetically and functionally better, Closed and Atraumatic technique, when performed professional way, will prevent tissue damage, provide maximal healing and minimal edema&swelling without a scar on your columella.Regards,

From the photos, it does appear that you have some collapse of the middle 1/3 of the nose resulting in the "inverted V" appearance.  This is caused by shadows forming between the nasal bones and the inward collapsed upper lateral cartilages just below the bones.  This can result after reduction of a dorsal hump, especially if nothing was done at surgery to prevent it.   The reason your breathing is affected is because when the upper lateral cartilages collapse inward, the internal nasal valve inside the nose becomes narrower, restricting airflow. The best prevention is placement of spreader grafts, which is also the fix for this when it has already happened from surgery. You should see an expert in rhinoplasty, who can evaluate your nose inside and out and advise you on what can be done to fix your cosmetic and functional issue. 

Unfortunately it does look like you have narrowing of the middle part of your nose with an inverted "V" deformity. This happens when the cartilage that forms the middle of the nose is not supported and collapses inward. From your photos it also appears the lower part of your airway is narrowed further restricting airflow. These problems can be repaired, and your nose could look better, by using your own cartilage to support and reshape the problem areas. This would mean another surgery. make sure you consult with an experienced rhinoplasty surgeon who is used to doing revision operations. 

Your analysis of your nose is impressive. Yes, you have an inverted V deformity due to  collapse of your internal nasal valve and disruption of your Dorsal aesthetic lines.  Also appear to have a septal deviation restricting your right airway. And open revision rhinoplasty is recommended.  In addition to correcting your deviated septum  spreader grafts would open  your internal nasal valve and support the med vault and improve your dorsal aesthetics lines.  Your asymmetries can be addressed better and additional refinement of your dorsal hump should also be performed at the same time.  You care to have them scan so care should be taken to camouflage any maneuvers so that you don’t have any external visible deformitys. 

Most of what you describe is fairly accurate.... Not at all to condemn the closed rhinoplasty approach as there are many talented surgeons who get great results this way, but your constellation of findings is what I see most commonly in my revision rhinoplasty practice. These are most commonly the result of destructive maneuvers during closed rhinoplasty that are left unsupported and subsequently  collapse, warp and contract after surgeryIt’s not about whether a revision is ‘easy’ or complicated, but rather that these operations need to be ‘complete’.... this includes a thorough evaluation, anatomical ly correct plan and meticulous surgeryRegardless of plastic surgery or ENT background, be sure to focus your vetting process on surgeons that are in practice for a long while, have a practice focused on rhinoplasty and have a predilection for revisionsGood luck