Is this the dreaded inverted V deformity? (Photos)

Question

Status post rhinoseptoplasty 2018. Unable to remember the details, but did have grafting from my ear to help build up the tip of my nose. Initially loved the appearance of my nose, however, progressively started to notice some deviation but chalked it up to poor lighting or the angle. Now, it is undeniably noticeable regardless of lighting or angle. Is this an inverted v deformity? What causes this? I understand revision is the next step, but what exactly should be done to help prevent this from happening again?

Gianfranco Frojo, MD · Answer

An inverted V deformity refers to a noticeable step off between the nasal bones and upper lateral cartilages. Essentially, in an open rhinoplasty an open roof deformity is created by cutting the upper lateral cartilages away from the septum at the dorsum of the nose. Overtime, the scar contracture can continue to show the change from the bones to the cartilages as the scar contracture pushes the cartilages down. This makes a noticeable step off between the bones and cartilages, which is called an inverted V deformity. I would recommend a revision as the nose is totally twisted. This often happens when the tension at the perpendicular plate (boney septum) was not properly addressed and now the L strut is twisting with healing. I would recommend a full revision rhinoplasty with rib autograft or allograft. You need a real expert certified by the American Board of Plastic Surgery. Ideally, this surgeon is also a member of The Aesthetic Society.

Andrew Miller, MD · Answer

Based on your photos, you are a good candidate for revision rhinoplasty. You don't appear to have an inverted V deformity. Sometimes, over time, scar contracture can pull the middle third of the nose one way or another. Also, your nasal dorsum appears too low on the side view. If the middle third is made too small, it might not hold up over time. This can be improved, usually, with spreader grafts, but you may need your bridge built up as well. Be sure to see a rhinoplasty expert for consultation.

Philip S. Schoenfeld, MD, FACS · Answer

From the photos you have provided, it appears that although there is a hint of the inverted V deformity that is not the issue that seems to be taking place. Some of the views that you were provided show a very nice result, but the one view from above shows significant dorsal deviation primarily of the cartilagenous portion of the nose. This likely occurred overtime due to scar contracture. None of the issues you’re having with your nose, however, impossible to fix and if that’s something you’re interested in then you should pursue this with an experienced revision rhinoplasty surgeon.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include placement of spreader grafts to improve the asymmetry of your dorsal aesthetic lines, nasal tip deprojection, corrrction of likely inverted V deformity, among other maneuvers. 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.
Harvard-trained plastic surgeon

Is this the dreaded inverted V deformity? (Photos)

Answers (4)

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

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Everything you need to know about Revision Rhinoplasty

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Is this the dreaded inverted V deformity? (Photos)

Answers (4)

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.