Inverted V Deformity correction with fillers? Or revision rhinoplasty? (Photo)

Question

I had a rhinoplasty in 2015 for a correction of a severely crooked nose. The result was a huge improvement to my breathing in addition to a much improved structure. Now I’m seeing a depression below the upper bridge which looks like an inverted V deformity. My breathing isn’t impacted. Could this be improved with fillers? Will this continue to get worse?

Eric M. Joseph, MD · Answer

If that is the case, a permanent nonsurgical nose job treatment may be helpful for achieving a straighter nasal appearance. I do not see evidence of an inverted V deformity. Thank you for your question. Sincerely, Dr. Joseph

Jason Emer, MD · Answer

Hello and thank you for your question. You have a tricky problem. It looks like your biggest issues are the inverted V deformity, as well as nasal tip and nostril asymmetry based on your pictures, with the right nostril having more show than the left. Your issues are unfortunately due to multiple reasons- the inverted V deformity is due to disruption of the connections between the upper lateral cartilages and nasal bones during your initial surgery, and the tip asymmetry and appearance is due to either the underlying cartilage construct or the resultant scarring after rhinoplasty which can contract and distort the overlying tissues (such as the nasal tip) and can cause alar retraction or other deformities to develop over time after surgery. These reasons are why it is important to perform certain maneuvers during rhinoplasty surgery to reinforce the underlying structural framework for the nose and tip which helps prevent such scarring and retraction. Given you've previously had a rhinoplasty, and there is no doubt extensive scar tissue present throughout your nose, including in your tip and alae, fillers would not be able to overcome the scarring, and only an open rhinoplasty can best address your issue.

In addition to addressing your aesthetic concerns, your septal cartilage (or an off-the-shelf alternative) would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in the columella (middle bottom portion of your nose between your nostrils) to really reinforce the tip and alae, and prevent recurrence of the alar retraction. As you've already had a rhinoplasty, likely your septal cartilage has been used already, so we'd use an off the shelf alternative (MTF cartilage).

The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. I would only recommend going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible.

Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided.

Dr. Donald Groves, our expert facial plastic surgeon, has extensive training and experience with complex rhinoplasty surgeries, so I’d recommend for you to come see him (or another plastic surgeon who is extremely comfortable with rhinoplasties) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Emer

Gabriele C. Miotto, MD · Answer

Thank you for your question. Non-surgical rhinoplasty or nose fillers can help improve the nasal shape, including minor refinements such as your case. Inverted "v" deformities can be corrected with a very small amount of fillers to the nasal dorsum and side wall. The best fillers for this purpose are Hyaluronic acid fillers and they last for about a year. You will need maintenance to keep the results (about once a year). An in-person consultation is the best way to do evaluate you and define the best product to use.
Hope this helps!
Best,
Dr Miotto

Ronald J. Edelson, MD · Answer

your inverted v is quite mild.  I would not bother with a revision rhinoplasty.  Overall the nose looks good.  You can try injectables if you like but I would leave it alone.

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for
your question.  Although it is difficult to assess from your photograph alone, an inverted V deformity is best treated with a revision rhinoplasty with spreader grafts.  If you don't have any breathing difficulty, fillers may improve the appearance, but this is obviously only a temporary fix, and it also carries the risk of vascular occlusion if a filler was to penetrate any vascular structures.  Please be careful.   I would recommend that you consult a
board-certified plastic surgeon who specializes in aesthetic plastic surgery, and routinely performs both nasal fillers and rhinoplasty.  If you seek the services of someone who predominantly performs "injectable rhinoplasty", then they will be intrinsically biased to giving you fillers.For more information on
rhinoplasty, please refer to the link below.
Good luck.
Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic
Plastic Surgeon

William Portuese, MD · Answer

Fillers offer a temporary augmentation to the nose, but it is important understand that there are limitations to what a filler can accomplish.  In addition, it is not FDA approved for that application and skin necrosis can be a potential complication.  To permanently fix the inverted V deformity requires a spreader graft composed of the patient's own cartilage placed underneath the concave upper lateral cartilage in the midportion of the nose, and osteotomies placed in the nasal bones.  This can be performed through a closed rhinoplasty approach with all of the incisions placed on the inside of the nose.

Darryl J. Blinski, MD · Answer

YES! But must find expert non surgical rhinoplasty MD injector. I think 1 syringe or less is needed of HA filler. Expect fees in $2,000++ ranges.

Richard W. Fleming, MD (retired) · Answer

It is difficult to see the problem you describe with these pictures. Fillers or a revision procedure with the use of spreader grafts are the most common treatments of an Inverted-V deformity. Please have an examination by a revision specialist to evaluate your nose and discuss alternatives; there are advantages and disadvantages of each.

Inverted V Deformity correction with fillers? Or revision rhinoplasty? (Photo)

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