Which procedures can correct an inverted v deformity?

Dear babygirl303,


An inverted V usually happens with the middle of nose falls in, or was inadequately supported at the time of spreader graft placement

It could also be the the bony part of the nose is not reduced adequately

If it has been longer than 6 months and you want it fixed, it would be a good time

An exam would help answer all of your questions and manage your expectations

Spreader grafts are great for opening the nasal airway to help you breathe better


Best regards,

Nima Shemirani

The width of the bony upper part of bridge should ideally be flush with the cartilaginous lower aspect of the bridge.  If the bone is wider and there is not a smooth transition below to the cartilage, an inverted V can result.  It is the lower edge of the bones that become visible (in the shape of an upside-down V), creating shadows that draw attention to the area.  If you have thin skin and/or short nasal bones, this problem can be more apparent. 

 

Spreader grafts are helpful to prevent this deformity, but their success depends on the planning and execution of the grafts.  They must have the appropriate width and position and must be adjusted to match the width of the bones.  

 

Fortunately, as revision problems go, this is an issue that is correctable with relative ease.  The spreaders may need to be repositioned, added to, or replaced.  The width of the bones may need to be adjusted.  Some combination of these are likely to take care of your problem if performed in the hands of an experienced revision surgeon.

 

The video link is to a portion of a lecture I gave on structural rhinoplasty.  In it, the concept of the inverted V is discussed.

To answer your question, an inverted-v deformity can occur if a hump is taken down and the middle vault is not supported with spreader grafts or the nasal bones are not adequately narrowed.  It is a width discrepancy between the bony vault and the middle cartilaginous portion of the nose.  Correction typically would require spreader grafts (if not used or larger ones) and possible re-fracture of the nasal bones to narrow.  It is important to have this examined by an experienced rhinoplasty surgeon. 

I need to ssee photos to determine if u have an inverted v deformity. For 35 years I have prevented this by using a precise size of the concavity and using an onlay graft of proper size before it occurs. This is probably what u need. 

Photos would really be helpful.  The problem may not be spreader grafts but could be inadequate nasal bone infracture, which is one of the most common reasons patients may require nasal revision and often will take care of the problem. I not a big fan of spreader grafts and have never found them to be needed; your problem couid be addressed by simply fracturing the bones more adequately

The inverted V deformity occurs when the dorsum, or bridge, of the nose is reduced, or lowered, and the sides of the nose which join the dorsum collapse downward. It is usually treated with revision surgery with cartilage spreader grafts, dorsal grafts or both. The spreader grafts are placed between the top (dorsum) of the central septum and the collapsed sides (upper lateral cartilages). If the bridge has been lowered too low, another graft is placed on top. Hope this helps.

An inverted V is created when upper lateral cartilages are inwardly displaced off of the nasal bones.  This could be created from a previous nasal surgery that included surgery on the upper lateral cartilages without osteotomies, or simple destabilization of the upper lateral cartilages themselves. At a minimum, the treatment for an inverted V is bilateral spreader grafts.  Osteotomies may or may not be performed depending upon the position of the nasal bones.  Sometimes the combination of both spreader grafts and osteotomies are performed to help with the inverted V deformity.  Look for a very experienced rhinoplasty surgeon who has experience in revision rhinoplasty before embarking on this difficult endeavor.

This deformity usually occurs when the bump on the nose is taken down too much and the upper lateral cartilages separate from the upper bony portion of the nose and sinks inward making the bone prominent and it looks like an upside down V. This is best treated by placing spreader grafts to recreate the attachments to the upper bony portion of the nose. Sometimes you will also need to add a fascia graft to camouflage the exposed bony portion of the nose. You are wise to seek a bard certified surgeon who is an expert at nasal revision and nose surgery in general.

An inverted V deformity can be from not infracturing the nasal bones adequately, as well as collapse of the middle vault this requiring spreader grafts. An exam is key.

The inverted V deformity is usually best corrected by spreader grafts as you have pointed out. But they must be placed high enough (right up against the bony dorsum) and be long enough to reach the dome to be optimally effective.  The upper lateral cartilages must also be properly sewn to them. The concept of spreader grafts is useful but they must also be applied properly to be optimally effective.