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

as time passes my nose is getting worse and worse. I am absolutely devestated by my results. are these problems difficult to fix? any recommendations for revision specialists on the east coast? This surgery has completely ruined my self esteem. how did this happen?

Doctor Answers 14

Inverted V Deformity after Rhinoplasty: Cause, Prevention and Correction

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


Bay Area Facial Plastic Surgeon
4.6 out of 5 stars 47 reviews

Some inverted-v deformities may be improved with injectable fillers.

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

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Revision rhinoplasty

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.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Correction of Inverted-V Deformity

Unfortunately you are correct, you do have an inverted-v deformity. A revision, with placement of cartilage grafts will be necessary to improve the appearance and probable nasal breathing obstruction.

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

Inverted V Deformity Rhinoplasty

An "Inverted V" deformity after nose surgery occurs when the upper segments of cartilage collapse against the septum. This can result from overly aggressive reduction of a dorsal hump and separation of the cartilage from the nasal bones during surgery. Prevention is the best treatment, and a surgeon should identify patients at risk for this and if it happens during surgery. Correction afterwards is possible and requires insertion of pieces of cartilage (spreader grafts) to reconstruct the proper width in that area. The pieces of cartilage can be taken from your septum if available or may need to be taken from your ear. This can restore both the appearance and function of your nose.

Cory Goldberg, MD
Toronto Plastic Surgeon
4.8 out of 5 stars 33 reviews

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

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.

Garrett A. Wirth, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 11 reviews

Inverted V After Rhinoplasty #nosejob

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.

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

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

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

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Inverted V Deformity

To correct this inverted V you will need cartilage spreader graft between the upper lateral cartilage and the septum. I addition the nasal bone may need some rasping, it's difficult to say without a lateral view.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 272 reviews

Inverted V deformity and collapse of the internal nasal valve after a rhinoplasty

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.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 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.