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Inverted V Deformity (Parenthesis Deformity)
The inverted V deformity refers to a cosmetic complication where the upper lateral cartilages of the nose collapse inward, creating a V-shaped depression in the middle of the nasal bridge. This deformity can occur due to over-resection of the nasal bones or cartilages during surgery, leading to inadequate structural support and collapse of the nasal sidewalls.
Separately, an over-aggressive dorsal reduction where too much bone or cartilage removed from the nasal dorsum (bridge), can weaken the support structure of the nose, causing the upper lateral cartilages to collapse inward. Insufficient support provided to the nasal sidewalls, particularly after hump reduction or osteotomies, can contribute to its development. As most other conditions of the nose, nasal trauma and congenital factors are also to blame.
Fix-It
Cartilage Repositioning / Reinforcement
Cartilage Repositioning / Reinforcement involves repositioning of the lower lateral cartilages through an open approach. Alternatively, techniques such as lateral crural strut grafts or modified alar battens may be employed to strengthen the nasal sidewalls and prevent recurrence of the inverted V deformity.
Spreader Grafts
Spreader Grafts are placed between the upper lateral cartilages and the septum to provide additional support and prevent collapse of the nasal sidewalls. Spreader grafts help widen the middle vault of the nose and correct the inverted V appearance.
Dorsal Augmentation
In cases where there is significant loss of nasal bridge height, dorsal augmentation with cartilage grafts (e.g. diced cartilage fascia grafts, dorsal onlay grafts) may be performed to restore contour and support.
Septal Reconstruction
Addressing any septal deviations or abnormalities through septoplasty can improve nasal airflow and provide foundational support for corrective procedures.
Revision Surgery
In more complex cases or when previous corrective attempts have been inadequate, revision rhinoplasty may be necessary to achieve optimal correction of the inverted V deformity.
