Do I have inverted v deformity or saddle nose deformity? (photos)

Question

I had the following surgeries together to restore my breathing, deviated septum, and reduce a hump after having suffered injuries to my nose years prior: septorhinopasty, nasal valve repair, turbinate reduction. The surgery took 7.5 hours and there were mentions of a fracture at the L-strut and a "keystone disruption at the time of surgery". I'm not sure what this means. The complications that I have/had following surgery include hematoma, synechia L+, narrowed airways, deviated septum.

Ronald J. Edelson, MD · Answer

You’ve been told a lot of techno speak. If you can breathe ok and are pleased with the result there’s nothing to do. You do not have an open roof or inverted v. If you want some further  refinement I suggest you find a surgeon who takes a more simplified approach.

Andrew Miller, MD · Answer

Based on your photos, you are a candidate for revision rhinoplasty. While I don't discretely see an open roof deformity, the bridge is low and appears a bit washed out. The open roof can be felt during an examination, so that is very important. Be sure to see a rhinoplasty specialist for consultation.

Gianfranco Frojo, MD · Answer

Yes, it appears that you do have an inverted V deformity. This may occur when the middle vault (composed of the upper lateral cartilages) is weakened from surgery and scar contracture continues to push these cartilage elements down while the bone of the boney vault (the nasal bones) remains stationary. Disruption of the keystone means that the upper lateral cartilages were disrupted from their attachments to the nasal bones; this is another reason for a potential inverted V deformity if not correct properly. You need a very complex revisionary rhinoplasty. You should see an actual plastic surgeon (trained in plastic surgery residency and ideally aesthetic plastic fellowship) who specializes in rhinoplasty. Best of luck.

Jeffrey Lisiecki, MD · Answer

In your after photos, it looks like you have a bit of an inverted V, though sometimes lighting can make this look more or less severe in photos as opposed to in person. You do have a low dorsum in the after photos (which may be the look you like), but no obvious saddle deformity. If there were these issues during the initial case, the real question would be how they addressed and repaired the keystone disruption and L-strut fracture. Being seen in person would be the best way to assess your concerns and formulate a plan for how to proceed.

Eric M. Joseph, MD · Answer

A “saddle nose” may occur after loss of support of the nasal cartilage. There tends to be a more exaggerated profile nasal curve than yours. If you feel like you would like your bridge raised permanently without further surgery, microdroplet Silikon-1000 nasal injections may be considered, depending on your condition. There is a link to photos of someone with a saddle nose attached.  Hope this helps! Dr Joseph

Do I have inverted v deformity or saddle nose deformity? (photos)

Answers (5)