What is this V shape caused by? What is the name of this area and what needs to be done to fix this? (Photos)

Question

I have an open septo-rhinoplasty 9 months ago and I am terribly unhappy with the results. I am afraid to have a revision and make matters worse, so I want to be able to be very clear with my new surgeon. What is this V shape I am seeing on the frontal view and how can it be improved? Do the risks outweigh the benefits if I underwent revision? Is there little improvement that can be made to my result? I have issues breathing as well. I feel much worse off than I was before surgery.

Ran Y. Rubinstein, MD · Answer

There are many reasons for deformities of the columella after.  This can include resection and destruction of the medial crura, failure to identify excessive curvature in the medial crura , poor placement of columellar grafts and struts, failure to identify deformity in the medial crural footplates, and a persistent deviation of the nasal septum.  It appears that your left nostril has what you are calling a "V-shape" as a result of your columella being pushed over to the left most likely due to a deviation in your nasal septum.  This is pushing your medial crura outward into the your nostril creating what you are calling this V shape.  I would recommend waiting a full year for final swelling to settle down before contemplating a revision.

Steven M. Denenberg, MD · Answer

Click on the "Web reference" link, just below my response, or go here:

FacialSurgery.com/RealSelf/RealSelf_lookitscrystal.html

I made a couple of computer morphs of your nose, and animations of the morphs, to show the changes that are possible for your nose in truly expert hands.

The main change I made was to elevate the tip of your nose. Your tip droops, and your nose is begging for a large elevation of the tip. Then, I also brought the entire nose back closer to your face, and narrowed the tip.

The V-shape you see is the drooping of the tip, which is improved by elevating the tip, like I did for the revision lady in the short video just above.

I'm curious whether the morphs fit with what you feel is a good goal for your nose. Did I raise the tip enough?

I reviewed your previous posts, too. With all due respect, you can't select a rhinoplasty surgeon based on his bedside manner. It just doesn't mean anything at all. Neither does board certifications or academic appointments or any of that alphabet soup stuff. In the link, underneath the morphs, I discuss how to find a good plastic surgeon.

I also have a section where I discuss how to tell whether you should let your primary surgeon do your revision. You need to read that section very, very carefully. All clues indicate that you should not.

The good news is that shortening a nose is one of the most predictable changes to make in a rhinoplasty, even in a revision.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Eric M. Joseph, MD · Answer

We only see one frontal preoperative photo. You appear to have a long and wide nasal appearance with a droopy nasal tip. The base view of your nose may reveal a deviated nasal septum. Revision surgery may be considered at 12 months postoperative, so now is a good time to begin consulting with rhinoplasty specialists. It may be helpful bringing a copy of your operative report and preoperative photos to your consultations. Depending on your condition, well-performed surgery may lead to improvement in both your nasal appearance and breathing. Wishing you all the best moving forward. Dr Joseph

Gerald Minniti, MD, FACS · Answer

Hello,The V shaped area is caused by your tip cartilage that is drooping downward. You should go to a few ABPS certified/ASAPS member surgeons that specialize in revision rhinoplasty. We can make it much, much better. Best of luck! Instagram: drgeraldminniti

Hagen Schumacher, PhD, FRCS(Plast), FEBOPRAS · Answer

Hello,

The shape is probably due to low cartilages (medial crura of lower lateral cartilages to be exact). Since the tip is also slight droopy (=ptotic), my personal approach would be to reposition the tip in a slightly higher position and to conservatively reduce any excess cartilage. This should improve the V-shape. You might also need cartilage spreader grafts between your septum and the upper lateral cartilages to improve the breathing. However, I am just guessing since I haven't examined you. After 9 months it is unlikely that things are improving without intervention.

What is this V shape caused by? What is the name of this area and what needs to be done to fix this? (Photos)

Answers (9)

Answer: Unacceptable Appearance After Rhinoplasty

Answer: Unacceptable Appearance After Rhinoplasty

Answer: V-shape

Answer: V-shape

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Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

What is this V shape caused by? What is the name of this area and what needs to be done to fix this? (Photos)

Answers (9)

Answer: Unacceptable Appearance After Rhinoplasty

Answer: Unacceptable Appearance After Rhinoplasty

Answer: V-shape

Answer: V-shape

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.