Condition
Inverted-V Deformity After Rhinoplasty
An inverted-V deformity appears as shadowing or narrowing in the middle vault after rhinoplasty. Its link to the internal valve, common causes, and how it is repaired.
ABFPRS
Facial Plastic & Reconstructive Surgery
ABOto
Otolaryngology — Head & Neck Surgery
AAFPRS
Fellowship Director
Overview
An inverted-V deformity shows up as visible shadowing or narrowing across the middle of the nose after rhinoplasty. Because the middle vault and the internal nasal valve are closely linked, it can affect both appearance and breathing.
Medically reviewed by Moustafa Mourad, MD, FACS — dual board-certified Facial Plastic & Reconstructive Surgeon and Otolaryngologist (Head & Neck Surgery).
Last reviewed: June 2026
Key takeaways
- An inverted-V deformity appears as shadowing or narrowing in the middle vault.
- It occurs when the upper lateral cartilages lose support, often after hump reduction.
- Because the middle vault relates to the internal valve, breathing can be affected.
- Repair commonly restores middle-vault support with spreader grafts or flaps.
- Evaluation includes photos, examination, endoscopy, and an airway assessment.
An Established Academic Authority
Double board certification. Fellowship director. Published author. A surgeon's surgeon.
ABFPRS
Board Certified
American Board of Facial Plastic & Reconstructive Surgery
ABOto
Board Certified
American Board of Otolaryngology — Head & Neck Surgery
AAFPRS
Fellowship Director
American Academy of Facial Plastic and Reconstructive Surgery
Textbook
Published Author
Contributions to the academic literature of facial plastic surgery
Dual board certification in both Facial Plastic & Reconstructive Surgery and Otolaryngology — Head & Neck Surgery.
Castle Connolly Top Doctor — Plastic Surgery, 2026What an inverted-V deformity is
An inverted-V deformity appears as visible shadowing or a narrow band across the middle vault of the nose after rhinoplasty. It tends to occur when the upper lateral cartilages lose their support and separate slightly from the nasal bones, casting the characteristic V-shaped shadow.
Why breathing can be involved
The middle vault is closely related to the internal nasal valve — the narrowest part of the airway. When middle-vault support is lost, patients may develop nasal obstruction along with the visible change, which is why this is assessed as both a cosmetic and a functional problem. See nasal valve collapse treatment for how the airway is addressed.
Common causes
Causes include hump reduction without adequate reconstruction of the dorsum, over-resection of cartilage, inherently weak cartilage, trauma, or scar contraction over time. Many cases follow a previous operation in which middle-vault support was not restored after the bridge was lowered.
Treatment
Repair generally restores middle-vault support. This often uses spreader grafts or spreader flaps to rebuild the dorsal framework, or broader revision rhinoplasty when more reconstruction is needed. Grafting material may come from the septum, ear, or rib cartilage depending on what is available.
Evaluation and next steps
Evaluation should include photographs, a thorough examination, nasal endoscopy, and an airway assessment to determine how much support is needed and where. To discuss repair, see the revision rhinoplasty page or schedule a consultation.
Frequently Asked
Inverted-V Deformity After Rhinoplasty — patient questions, honestly answered.
It usually occurs when the upper lateral cartilages lose support — often after a nasal hump is reduced without adequately reconstructing the dorsum. Over-resection, weak cartilage, trauma, and scar contraction can also contribute, producing the characteristic V-shaped shadow across the middle vault.
It can. The middle vault is closely linked to the internal nasal valve, the narrowest part of the airway, so loss of middle-vault support can cause nasal obstruction along with the visible change. It is assessed as both a cosmetic and a functional issue.
Repair restores middle-vault support, commonly with spreader grafts or spreader flaps, or broader revision rhinoplasty when more reconstruction is required. Grafting material may come from the septum, ear, or rib cartilage depending on availability.
Evaluation includes photographs, a thorough examination, nasal endoscopy, and an airway assessment. These establish how much support is needed and where, so the repair can be planned precisely.
Continue exploring
Related rhinoplasty resources
Revision Rhinoplasty
Restoring middle-vault support after prior surgery.
Nasal Valve Collapse Treatment
Addressing the internal valve and airway.
Nasal Valve Collapse After Rhinoplasty
A closely related post-surgical breathing problem.
Rib Cartilage Revision Rhinoplasty
Grafting options for middle-vault reconstruction.
Schedule a consultation
Have an inverted-V deformity evaluated.
Next step
Plans are individualized. The consultation is where that begins.
Reach the Manhattan office to schedule a private consultation with Dr. Mourad.