5 Months Post Rhinoplasty Inverted V? How Do I Fix This? (photo)

Thanks for the question. You definitely appear to have an inverted V deformity which is the collapse of the upper lateral cartilages against the septum. When a hump is removed during rhinoplasty, spreader grafts are often placed along each side of the septum to prevent this from happening. This maneuver can improve the patient's ability to breathe as well. While spreader grafts are not needed for every patient, those with long narrow upper lateral cartilages are at particular risk of inverted V deformity without these grafts. I place thin spreaders on nearly every rhinoplasty I perform. If there is enough cartilage left in your septum, revision rhinoplasty with placement of these grafts should be straightforward for surgeons who specialize in revision rhinoplasty. An open approach would be best, in my opinion. If septal cartilage has been used up during your first surgery, ear or rib cartilage can be used.

Feel free to direct message me if I can be of help or can refer you to surgeons near you. Lastly, if you are having difficulty breathing, it's possible that insurance coverage may be obtained for your surgery. Finding an in-network rhinoplasty specialist might be worthwhile for you. Hang in there... 

Warmest regards,

Dr. Mehta

 

I read your concerns and reviewed your photos:

Consider re-asking your question with profile photos which would be helpful for evaluation.

It may be best to keep a surgical option as a last resort. Depending on your examination, an injectable filler may be considered. My personal experience is with Silikon-1000, an off-label filler for permanent results.

Hope this helps you.

Dr. Joseph

A small graft of cartilage on each side is what I have used for 35 years when patients like u r referred to me. If they want a quick fix that lasts 1 year fillers r used. 

An inverted V deformity occurs when there is a discrepancy in the nasal bone width versus the width of the upper lateral cartilages, typically where the upper lateral cartilages collapse inward too much after a hump reduction. It is best treated with spreader grafts to stent the upper lateral cartilages outward. The spreader grafts need to be customized for the particular situation, as there are different variations of an invertedV deformity, and asymmetries and skin thickness may play a part in the overall treatment. Spreader grafts typically are made of septum or ear (or occasionally rib cartilage), depending on what material you have available and how much volume is needed to realigned your nasal width issues. Repair of the invertedV deformity is routine in my practice, and our office could put you in contact with prior patients who have had the deformity repaired. When seeking care for your situation, find a surgeon who treats a high volume of revison rhinoplasty patients and who can demonstrate numerous examples of inverted V deformity repair by showing you before and after photos during your consultation. I hope this information helps you. Best of luck!

Unfortunately I agree with you on the inverted V deformity.  It can be corrected although it is not always a simple procedure.  I suspect you would most benefit from cartilage spreader grafts and fascia graft.

This is a pretty classic inverted V deformity. It is fixed by placing spreader grafts which are cartilage grafts placed in that area parallel to the nasal septum to restore support to the upper lateral cartilages. The upper lateral cartilages are often re-positioned and sewn to the spreader grafts. I have also had to place small onlay grafts at times too, which is cartilage laid over the surface of the top of the nose in that area to help camouflage. You may need a small piece a tissue that we call fascia placed there for smoothness. Do yourself a favor. Choose a board certified surgeon who does lots and lots and lots and lots and lots of nasal revision surgery.

You concerns are supported by your posted photos. You have a severe inverted V mid-nasal vault collapse that is also visible in the view up the nostrils. You will need cartilage grafts placed between the side cartilages in the mid-nose and the septal cartilage in the midline(spreader grafts) to open the mid-vault. This may be best done with an open approach in order to stitch the grafts in place.

How this happened is not clear from the limited information in your post. It sounds like you have lost faith in your primary surgeon and will not return to him/her which is too bad. What follow up did you have with that surgeon after surgery and what did he/she say? If you decide to go to another surgeon it would be best if you brought the operative report and before surgery pictures with you.

5 months is a bit too early to have revision surgery but is a good time to start visiting and considering surgeons for the revision.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

You have three options: 1. live with this, 2. fillers to correct the V deformity, 3. spreader grBest to obtain in person evaluations 

You do have an inverted V type deformity which causes a collapse of the internal nasal valve on inspiration.  This could be due to an over resection of the upper lateral cartilages or an existing internal problem. To correct this deformity requires a secondary rhinoplasty and insertion of spreader grafts.  

Agree with previous posts. You will need either cartilage from the Septum, if available, or Rib Cartilage, donor or your own, to fix this problem. Ear Cartilage in my experience is too curved and too weak.

These are called spreader grafts, the trick is to ensure the surgeon makes them the right size for your problem.

In experienced hands, this should give you an excellent outcome.

 

Best,