Inverted V?

it appears that I have an inverted v. I'm confused cause my doc did say he was using a spreader graft in my nose and after reading on real self I saw that the inverted v usually happens when it just weakens and to fix it you would need a graft? How exactly does a inverted v occurr? I am looking into correcting this, but I am planning to go with a new doctor... what procedures are done with correcting an inverted v deformity? Thanks.

Doctor Answers 13

Revision Rhinoplasty surgery

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

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Inverted V deformity

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.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Inverted V after Rhinoplasty #nosejob

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.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 49 reviews

Causes and Solutions for Inverted V Deformity

An inverted V is simply the shadowing caused by the visible edge of the nasal bone.  The reason why this occurs during rhinoplasty, at times, has to do with the upper cartilages being detached from the septum and falling into the nose.  This highlights their attachment to the nasal bones and the nasal bones appear as a ridge above the collapsed upper cartilage.  The reason why the upper cartilages falls in is because the natural width of the nose has been removed with hump reduction.  The repair involves using cartilage grafts called spreader grafts which are matchstick shape pieces of cartilage which push the nasal upper cartilage outward, and smoothes the surface transition between the bone and the upper cartilage so that that shadow disappears.  If this doesn't work, revision involving wider spreader grafts and possibly further infracturing of the bone is necessary  Occasionally if the skin is very thin camouflaging can help the situation.  I usually use fascia from the temple to thicken that skin and improve the contour.  You should definitely see an experienced rhinoplasty surgeon who is well versed in this technically difficult and aesthetically challenging problem.

Jeffrey Rawnsley, MD
Los Angeles Facial Plastic Surgeon
4.7 out of 5 stars 19 reviews

Inverted V Deformity

Spreader grafts are usually the ideal treatment for the inverted V deformity caused by a collapse of the mid-portion of the nose. I need pictures to make recommendations for the correction of your problem. You want to consult with a surgeon who specializes in revision rhinoplasty.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

An inverted-V is a contour problem

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.

David W. Kim, MD
Bay Area Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

Inverted V-deformity following rhinoplasty

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. 

Amir M. Karam, MD
San Diego Facial Plastic Surgeon
4.6 out of 5 stars 114 reviews

Inverted V deformity

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.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Inverted v deformity and treatment.

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. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Inverted V

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.   Have never used them nor had a desire to. some surgeons use them in everyone,and I have no idea why.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

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.