Getting Technical: Deformities & Reductions

What is an inverted-V deformity?

An inverted-V deformity can occur after a rhinoplasty if the cartilages are not sewn back up together. Typically, on frontal view, you see an upside down V in between the bones, which are the top third of the nose, and the cartilage, which is the lower two-thirds of the nose. The treatment of this is restoring the normal cartilaginous anatomy. The solution involves either placing spreader grafts, which are placed between the side cartilages and the septum, or just resuturing the side cartilages back up to the septum. This will help treat the inverted-V deformity.

What is an Open Roof Deformity?

An open roof deformity occurs when a hump is taken down and the nasal bones are not narrowed to close the gap after removing the hump. The top part of the nose is made up of three bones, two on the sides and one in the middle, which meet in a triangle-type shape. When the hump is removed, the walls are separated from the middle and if the nasal bones are not properly brought in, then the patient is left with a wide and flat nose. If you think you have one, you can run your finger along the bridge of the nose and see if you can feel a gap between the nasal bones. This problem is easily fixed with a small revision procedure where the nasal bones are reset more towards the middle, which will, in effect, close the gap and give a more narrowed and defined nasal bridge.

Can reducing the alar base or the nostril flare cause the upper lip to look smaller?

In an alar base reduction, we narrow the nostrils by making a small incision within the crease of the nostril. When done properly it only narrows the nostrils and does not change the position of the upper lip. In fact, most people use a similar incision to lift up the lip, so it would not make it smaller.

If I have a large reduction in the size of my nose, would I have puffy skin afterwards?

Frequently we see patients who have thick nasal skin and it is very tempting for the surgeon to remove cartilage to bring down the bridge or make the nose smaller. There is a limit to how small you can make the nose just by reducing the cartilage because the skin will not shrink wrap around it very easily. In patients with thick nasal skin, it is more common for the skin to remain thick and scar tissue to form underneath.