Is it hard to tell the difference between inverted v & open roof?

1 side of nose looks/feels like the bone shifted laterally causing a gap between the bone and septum.Its been 2 years since my surgery. Note:I do have spreader grafts. I know to fix an inverted V you place spreader grafts and to close an open roof I would require an osteotomy. my question is if I already have spreader grafts in there, does it mean its most likely an open roof & not an inverted V? Can my surgeon still perform an osteotomy (only on the one side) with a spreader graft in there? Thank you!

Doctor Answers 5

Open roof?

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You may very well have an open roof which basically means that if osteotomies were done in the past, they didn't bring the nasal bones to gether well enough and need to be done again.  Best to be seen in person.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Difference Between Open Roof and Inverted V Deformity

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You raise some excellent questions which will be best answered by submitting pictures and/or having a consultation rather than self diagnosing the problem by asking question in this forum.  

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Open roof and inverted V deformity in rhinoplasty

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Dear Lalaland310,

  • It sounds like you may have an open roof, which is the gap that you would feel when you move your finger from the area between the eyebrows and down toward the tip, in the middle of the bridge
  • An inverted V is something that you would feel along the sides of the nose as well as the middle of the bridge of the nose
  • The good news is that you can perform an osteotomy with a spreader graft
  • Sometimes, when an osteotomy is incomplete, it does not move inwards completely (which is another cause of an open roof)

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Revision Rhinoplasty Questions

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Thank you for the great questions! It is possible to have one or both an inverted V and/or open roof deformity. The inverted V happens when the cartilages are accidentally separated from the nasal bones. This causes a palpable or visible step-off that looks like an upside down letter V. An open roof is when a bump is taken off the nose and the nose bones no longer meet in the middle.  This is generally palpable as two separate edges of bone in the middle of the bridge. Each of these can be corrected during a revision rhinoplasty -- even if spreader grafts are present. Best of luck moving forward!

#San Francisco Rhinoplasty

Revision Rhinoplasty for open roof deformity

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Dear Lalaland, thank you for your question.Revision rhinoplasty is a complex procedure that requires experience and skill, and is a focus of our San Diego practice. Look for an experienced board certified Facial Plastic Surgeon who can demonstrate excellent results. Good Luck!

Roy A. David, MD
San Diego Facial 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.