Dent on my left dorsal line making it asymmetric - Do I have an inverted v deformity? (Photos)

Question

i’m 9 months post op and my swelling is finally going down but then i started noticing a dent on my left dorsal line making it asymmetric

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you do have some asymmetry in the upper dorsum but I don’t see an inverted V deformity. This can likely be improved with a revision. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Semih Yildiz, MD, FEBOPRAS · Answer

In the two patient photos, there appears to be a small depression or shadow along the left middle nasal sidewall. An inverted-V deformity occurs when the upper lateral cartilages are inadequately supported beneath the nasal bones, creating a visible step or V-shaped shadow at the middle vault and sometimes nasal-valve narrowing. It may be asymmetric, but lighting, head angle, residual swelling, scar contraction, or a small contour irregularity can look similar in photographs.

At nine months, the nose is still healing and uneven swelling can continue to change for 12 to 18 months, especially in the middle vault and tip. Your treating surgeon should examine and palpate the area, compare serial standardized photographs, and assess whether you have new one-sided obstruction or collapse during inspiration. Those findings help distinguish a surface contour issue from structural middle-vault weakness.

If the depression persists after healing and is purely superficial, a small cartilage or fascia camouflage graft may be enough. If there is true upper-lateral-cartilage separation or valve compromise, revision reconstruction with a spreader graft, spreader flap, or other structural support may be needed. The appropriate correction depends on the exact defect.

Do not inject steroid into a dent, because it can thin the tissue further. Filler in a previously operated nose carries vascular risk and should not be used casually as a diagnostic test. Arrange an in-person review with your surgeon now, then document the contour under identical lighting every few months before deciding on revision unless breathing is worsening or the framework is unstable.

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have thin nasal skin, and it is the thinnest where you are seeing this bony irregularity. Rather than considering revision rhinoplasty surgery, microdroplet Silikon-1000 injections maybe considered for filling and camouflaging this area of visible bone. I hope this helps! Sincerely, Dr Joseph

Ronald J. Edelson, MD · Answer

I see what you are saying and that is because when the bones were broken the bridge was not made narrow enough.  The other thing I notice is that your nose was left too long but that’s quite simple to correct

Alejandro Nogueira, MD · Answer

Inverted V deformity and open roof deformity are always associated and sooner than later surface together as a combo resulting the lack of proper osteotomies (infractures) once the hump has been removed (aka "removing/opening the roof".

Failiing to close the roof with osteotomies leads to visible slots at the osseous dorsum, which is the issue you complain about, and later to the collapse of the cartilagenous dorsum which collapses inwards and dissociates / dislocates from the bony walls of the nose.

Briefly and simplistically said, the solution is a revision rhinoplasty to accomplish proper closure of the roof by infracturing and applying spacer/spreader grafts at the middle vault, plus another series of corrections needed in your nose as per the photos you've showed.

Seek the help of an experienced revision rhinoplasty surgeon.

Darryl J. Blinski, MD · Answer

Based on your two post of photos, this denting affect is minimally noticeable best corrected by injections of HA fillers in a few sessions expect fees to arrange from $5000-$1000 per session. Best of virtual concert with for more info.

Dent on my left dorsal line making it asymmetric - Do I have an inverted v deformity? (Photos)

Answers (6)

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