Inverted V after rhino. What option should I choose? Please, help me to make a decision (Photo)

Question

I have an inverted V deformity after my rhinoplasty. There is a dent and a shadow on the bridge, and a crease is going down on both sides. My nostrils are asymmetrical, breathing is ok. One surgeon proposed my rib cartilage spreader and alloderm. He says I have small ears, not enough if my tip drops after he lifts the skin. He does not suggest touching my nostril. Another surgeon proposed an ear cartilage spreader and onlay diced cartilage. And reduce one nostril 1-2 mm. What is best?

Man Koon Suh, MD · Answer

Definite correction of inverted-V deformity will be spreader graft on both sides of dorsal septum.For spreader graft, the size of ear cartilage is not small.Dented area on the mid-part of nasal dorsum requires additional cartilage graft and to avoid visibility of the graft, crushed cartilage or diced cartilage will be preferred.

Eric M. Joseph, MD · Answer

You appear to have thin nasal skin, and that can be a setup for seeing indentations and irregularities after rhinoplasty. Depending on your examination, microdroplet silikon-1000 nasal injections may be considered for achieving a "less operated" nasal appearance - especially if your nose looked better when it was still swollen. Hope this helps! Dr Joseph

Steven M. Denenberg, MD · Answer

While theoretically spreaders can correct an inverted V, IMO a much better approach would be to further narrow the nasal bones a bit and *maybe* a very thin graft to the depressed area, a graft taken from inside the nose, not the ear or rib. Spreaders would be a guarantee of quite noticeably widening your nose, and I somehow think you wouldn't like that. When I look at your nose, I would also think of narrowing the lower half, and even elevating the tip a bit. Both of those movements would make the nose smaller, whereas a rib graft would make the nose quite a bit bigger.
How *much* to narrow the bones, or elevate the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)
Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.

William Portuese, MD · Answer

Much more information is needed, such as a copy of your operative report to find out how much cartilage you have leftover on the inside of your nose for grafting purposes. The inverted V deformity is treated with osteotomies placed in the wide nasal bones to narrow them, and spreader graft placement in the upper lateral cartilages to widen them and give more support.. Your nostrils are asymmetrical now and will still be asymmetrical after the surgery, but they could probably be improved only slightly

Inverted V after rhino. What option should I choose? Please, help me to make a decision (Photo)

Answers (4)

Answer: Inverted V after rhinoplasty

Answer: Inverted V after rhinoplasty

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.

Inverted V after rhino. What option should I choose? Please, help me to make a decision (Photo)

Answers (4)

Answer: Inverted V after rhinoplasty

Answer: Inverted V after rhinoplasty

Browse related questions

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.