Is this a middle vault collapse? What is the treatment? I year post-op. (photos)

Question

I had a rhinoplasty a year ago. Upon healing, i began to see that the middle portion of my nose would dip inwards. There is clear improvement from my old nose, but the dip and remaining bump do make me insecure. I would like to know some possible reccomendations. I did visit my primary surgeon, but he said he would fix this problem by rasping the sides of the bones sidewall and the bump off as well as lifting the tip. Personally, im not sure if this is the correct way of handling this narrow issue...

Alejandro Nogueira, MD · Answer

You are right about your judgements, your nose shows several issues, some correctly pointed out, and the solution is not AT ALL the one proposed.
Here is my list of detected issues and solutions:
-open roof deformity: your bones and dorsum are broad, this needs proper parasagital bone release or resection pluse well performed osteotomies to render a thin and defined dorsum
-pinched middle vault with double collapse: the double collapse means inverted V deformity due to anterior collapse of the lateral cartilages.... but such "V" is non-visible because there is a profile collapse and a sunken dorsum (did you get any septal work as well? seems so) with a short saddle nose deformity at the supratip; this has complex solution: the pincheed vault is treated with spacer grafts, and the sunken supratip with onlay grafting, which might require additional temporalis fascia graft to camouflage its visibility
-seems a portion of the right upper lateral cartilage is missing or folded in or similar... odd issue... needs intraop assessment and repair
-remnant hump: needs shaving
-poor or no tip work with apparent poor support: this may need columellar structs, plasties, plications and grafing of the tip; to be assessed intraop
You need a surgeon with vast experience in revisions, do research well and seek better opinions.
Better images are required to provide overal assessment of your nose.
Feel free to request any additional information from me.

Toby Mayer, MD · Answer

Revision rhinoplasty for nasal dorsum depression and lateral mid collapse , etc. is corrected by adding cartilage and soft tissue grafts to fill in these. The hump may or may not need reducing but I need to see if this is too high as well. See a very experienced revision rhinoplasty surgeon to correct this.

Steven M. Denenberg, MD · Answer

Click on the "Web reference" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_kari2610.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.You've been asking about a middle vault collapse for a while. There might be a tiny amount of that, but it's only a small part of what's going on. When that right three-quarters view that you posted looks like a big bump where the bone is, and a bump where the tip is, and a depression in between those bumps, then yes, that depression might be a tiny "collapse," but really, we see the depression there because the boney part of the nose is too prominent, making the bump above the dent, and the tip is too prominent, making the bump below the dent. If the bone and the tip were less prominent, we probably wouldn't see the dent at all!In the morph, I simulated narrowing the boney part of the nose, and narrowing *and elevating* the tip. I'd like to see your tip up a bunch.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and how to tell whether your primary surgeon should be performing your revision. You should only have surgery if you are able to make yourself very confident in your surgeon's skills.
I'd love to hear what you think of the morph. Did it seem to address your main concerns?
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery. You don't want to be looking for yet another revision later.

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. In a matter of speaking it might be a middle vault collapse. That being said, patients with MVC typically complain of difficulty breathing, especially on hard inspiration. Is that something you are experiencing? If not, your surgeon's plan is reasonable as long as your bridge height isn't lowered too much. Another option is to add soft tissue fill or filler to the bridge to smooth it out. Filler can be injected in the office under local anesthesia. Soft tissue filler could be added in a minor surgical procedure. If you have MVC, then you need a revision rhinoplasty to reposition the upper lateral cartilages and may need spreader grafts to improve your dorsal nasal lines. Additional rasping may still be necessary.Good luck,Dr. Shah

Jerold Olson, MD · Answer

Hello,
It can be somewhat difficult judging from your photos but my sense is the middle third of your nose is slightly more narrowed and low than it should be. This is more noticeable because the upper third is a bit elevated and wide. I would think a revision procedure would need to address both these areas. Whether or not further refinement of the nasal tip is required would depend on the multiple factors based primarily on your anatomy, length of time from the original procedure, and the original appearance of your nasal tip. In your situation I would think that computer imaging of your current photos would be helpful in making decisions about how to proceed.
Best of luck.

Is this a middle vault collapse? What is the treatment? I year post-op. (photos)

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Answer: Is this a middle vault collapse? What is the treatment? I year post-op.

Answer: Is this a middle vault collapse? What is the treatment? I year post-op.

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

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Is this a middle vault collapse? What is the treatment? I year post-op. (photos)

Answers (7)

Answer: Is this a middle vault collapse? What is the treatment? I year post-op.

Answer: Is this a middle vault collapse? What is the treatment? I year post-op.

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

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Everything you need to know about Revision Rhinoplasty

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