Is this a mid vault collapse 1 year post-op? (photo)

Question

Hello, I got a rhinoseptoplasty with turbinate reduction November of 2023. I noticed immediately after surgery that I had a prominent line on my nose that lined up with my nasolabial fold. As the swelling has gone down it has become less noticeable, but I can still feel a strange sensation almost like sagging pressure and still see a faint line. Is this a mid vault collapse? Would I need an open rhinoplasty to add a rib graft or can this be done closed? My primary rhinoplasty was closed. Thanks

Eric M. Joseph, MD · Answer

In general, revision rhinoplasty should be reserved for severe dissatisfaction with somebody's nasal appearance after previous surgery, or nasal obstruction after previous surgery. If you are seeing an indentation, or a crease, depending on your examination, microdroplet Silikon-1000 maybe considered fulfilling it in, and this may be a welcome substitute for the surgery. Thank you for this question, and I hope it helps. Sincerely, Dr Joseph

Lucian Ion, FRCS · Answer

Thank you for your inquiry and for sharing your photographs.

Without a true profile view, it is more challenging to provide a comprehensive assessment. However, my general impression is that the nasal tip has been well supported, which may cause it to stand out more prominently than before. This can create the appearance of a relative deficiency in the middle vault and make the supratip break more noticeable.

If the nasal skin is thicker, surgical efforts often focus on avoiding the development of a supratip soft tissue pollybeak deformity. It is quite likely that your surgeon aimed to prevent this issue when supporting the nasal tip. The softness you are noticing above the tip may be due to a gap between the support structures of the bridge and the tip, where the soft tissues are tenting over this space.

Unless you have specific aesthetic concerns that you wish to address, there is no need for additional intervention, as the nose does not appear to be collapsing or structurally compromised. However, if you are interested in modifying the shape, both closed and open surgical approaches can be considered to enhance projection in the middle vault. This should be discussed in detail with your surgeon, taking into account the characteristics of your skin and your expectations for the outcome.

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided a true lateral view. In some of the views, it looks like you have a super tip hollow and that may be what you are concerned about. The tip of the nose is slightly broad. I recommend an open rhinoplasty to correct this. You may not need rib grafting but may need cadaver cartilage to correct the super tip hollow.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

If you have mid vault collapse it is minor. As long as you don’t have any breathing problems I would not recommend surgery. Your result is good

Zoran Potparic, MD · Answer

Based on these photos,  it is very likely that this is secondary deformity based on the collapse of mid lateral vault (upper lateral cartilage). In your case, in particular if you do not have any issues with obstruction, correction with a small amount of HA filler may be quite acceptable solution. Good luck.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a revision with placement of spreader grafts to help improve the symmetry of your mid vault. Nasal tip deprojection and tip refinement could be performed at the same time to help improve the appearance of your tip. 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

Best wishes and good luck.

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

William Portuese, MD · Answer

You have a very slight inverted V deformity with slightly wide nasal bones, and slightly collapsed upper lateral cartilages. Your nose actually looks pretty good, there's no reason to rush in right away and perform a revision rhinoplasty. You have a very reasonable looking nose. If you end up doing a revision rhinoplasty, it can be done through a closed rhinoplasty with placement of spreader graphs to widen the mid vault, and osteotomy to narrow the nasal bones. It's very important to know how much cartilage is left over on the inside of your nose for grafting purposes.

Is this a mid vault collapse 1 year post-op? (photo)

Answers (7)

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