How does a middle vault collapse happen? Will I require an open revision surgery to correct my nose? (photos)

Septorhinoplasty Jan 2016. My nose has collapsed inwards and appears as a "dent" on my right side. I am also still having difficulty breathing through my left nostril and my alar creases do not appear symmetrical. Will I need an open revision rhinoplasty to fix these concerns? What can be done cosmetically to improve the appearance of my nose? My surgeon also told me he could put fillers in the indented area which I am not comfortable with as I feel this is a "temporary fix". Please help!

Doctor Answers 7

Revision rhinoplasty

Hi,  Your fotos do demonstrate middle vault collapse on your right side.  If during the original surgery the bridge of your nose was lowered,  this is usually done to remove a bump on the bridge, then the nasal bones will require osteotomies to move them closer together to close what is called an open roof deformity.  If this is not done or if your right nasal bone did not move in enough then the middle cartilage on the side of your nose falls inward and causes the collapse which can block the airway and cause the nose to look like yours on the right.  It also appears that the tip of your nose was twisted before surgery and was not corrected.  The correction of your concerns would be determined during a consultation.  If you only want themiddle vault collapse corrected then the procedure is less involved but probably more cosmetic improvement than improving the breathing. I would recommend that you seek another opinion to discuss the best way to correct your concerns. 

Detroit Plastic Surgeon
4.7 out of 5 stars 37 reviews

Middle vault collapse....

This is a good question; the middle vault is the central portion of the bridge between the nasal bones and the tip.  It is important both for appearance and function.  As to appearance, it is nice to have the width along a nice line running from the inside of the brow along the nasal bones all the way to the tip.  As to function, it is nice to have a smooth line all along the bridge on the right and left side.  Based on your photos, it appears you have a cosmetic problem on the right side that can be nicely improved with a spreader graft.  On the opposite side though is the breathing problem and that will require a careful intranasal exam by an experienced surgeon.  That issue could be a crookedness of your septum, an enlarged turbinate or a number of other factors.  These most likely can be improved with revision surgery.  I would wait an entire year for almost all the swelling to go away so that your best plan can be made for the revision surgery. I hope you find this information helpful. 

Thomas Hubbard, MD, FACS
Virginia Beach Plastic Surgeon
4.8 out of 5 stars 37 reviews


A temporary fix is with fillers, a more permanent fix is with revision rhinoplasty.  Best of luck....

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Open Revision Surgery to Correct Middle Vault Collapse?

You're correct when you state that fillers provide a temporary result and they will not correct breathing problems. Surgery, such as the placement of a spreader graft, will provide a permanent result which is an important consideration in a young lady like yourself. I also question if you have some septal deviation or tip asymmetry.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Spreader graft for mid-vault collapse

 When patients have mid-vault collapse on either one or both sides, cartilaginous spreader graft placement is usually performed  to augment that area on a permanent basis.  For more information and many examples, please see the link and the video below 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Rhinoplasty with depression

I really believe that you should discuss this issue with your surgeon as you already did but more so in light of a possible revision rhinoplasty which in expert hands will produce the result you would like. Fillers are a temporary fix but in that area they will last up to a year after each injection and in some cases that is a viable option too.

Vartan Mardirossian, MD
Jupiter Facial Plastic Surgeon
4.8 out of 5 stars 40 reviews

Vault Collapse Question

Thank you for your question!  I am sorry you are having these difficulties after your operation.  Middle vault collapse can be caused for several reasons.  Most often, we will see it after a trauma or after surgery.  This condition is something that I will often point out to my patients, because if it is not corrected during the first surgery, it will be noticeable afterwards (and oftentimes it can be overlooked, because the focus is on other aspects of the nose). The most common surgical treatment for middle vault collapse is placement of a cartilage spreader graft.  

At this point, I would discuss your concerns with your surgeon.  Filler may be a good option to help camouflage this collapse, but will not be a permanent solution nor help with your breathing issues.  If you seek a second consultation, be sure it is with a board certified facial plastic or plastic surgeon who specializes in rhinoplasty. 

I hope that this helps!

-David Gilpin

David Gilpin, MD
Nashville Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.