What options are available just to lift the cleft-deficiency (v-shaped dip) to something more natural-shaped? (Photos)

Question

Hello - male, 39, Asian. Please see attached photo of uneven nostril floor-— What surgical techniques or options are available just to lift the cleft-deficiency (v-shaped dip, red) to something more natural-shaped (yellow)? Note, there is sufficient skin covering-—ie, the dip naturally pulls up when smiling. But what can be done to fill in/raise/fix that area? Please advise, thank you.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a fascial graft of the nasal sill floor to help provide improved symmetry. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. With good surgical technique, you could have an outstanding result. 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. FACS
Harvard-trained board certified plastic surgeon

Best wishes and good luck.

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

Randal Haworth, MD, FACS · Answer

From a single photo, without seeing you at rest, smiling and from below, I can only speak in general terms. A V-shaped notch in the nostril floor on one side usually reflects missing tissue rather than excess, and the first job is to sort out which layer is short: the soft tissue of the nostril sill itself, the orbicularis muscle running beneath it, or the bone of the upper jaw and piriform rim underneath. The fact that the dip lifts when you smile tells you the skin is adequate, which helps, because it points toward a support or volume deficit. Sometimes this pattern is a very subtle, microform cleft-type difference that has been present since birth. Depending on the cause, options generally include:1. Fat grafting or a small dermal-fat graft to fill out the sill; relatively simple, though part of the fat may not persist.2. Cartilage grafts, diced or shaped, to build up the sill or alar base where structure is missing.3. Local tissue rearrangement, such as a small V-Y advancement or Z-plasty, when the muscle and sill contour themselves need to be realigned.4. Augmentation of the bony base beneath the nose with cartilage or an implant when the foundation is set back.Each has trade-offs in scarring, predictability and how the nostril shape changes, and small asymmetries of the nostril floor are notoriously demanding to correct precisely. An in-person exam with a board-certified surgeon experienced in nasal base and cleft-type refinements is the right way to decide which of these, if any, fits your anatomy.

What options are available just to lift the cleft-deficiency (v-shaped dip) to something more natural-shaped? (Photos)

Answers (2)

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