Revision Rhinoplasty: Q&A

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Breathing Problems: Spreader Graft or Alar Batten Grafts?

Hi, I had a rhinoplasty done some years ago but am planning to have a revision now. As you can see on the picture, my nose is crooked, but I also have breathing problems. When inspiring deeply my nasal valve moves inward. I consulted different revision specialists, and some suggest alar batten grafts to correct my breathing problem, others suggest a spreader graft. I don't know what is best now. Can anyone help?

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8 Doctor Answers | Asked by MissLouise in Europe

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Nasal valve collapse

Spreader grafts may prevent nasal valve collapse but rarely help correct it. Alar batten grafts (lateral crural strut grafts) with or without lateral crural repositioning are likely your best option.

Sam Naficy, MD

84 reviews

Seattle Facial Plastic Surgeon

www.seattleface.com

Valve collapse and cephalically positioned lower lateral crura

I agree with Dr. Bridges' assessment that you appear to have cephalically positioned lower lateral crura. Rather than being oriented approximately 45 degrees off center, they're angled up more than ideal. The overall effect is decreased support of the sidewall of your nose (external valve). Alar batten grafts are cartilage grafts placed in this area to improve the support and decrease the dynamic collapse. In cases like this, I find that lower lateral crural repositioning is... more

Spreader Graft or Alar Batten Graft for Rhinoplasty

Either graft may be useful to open the nasal cavity to allow easier breathing. Whether you need grafts inside (spreader) or outside (alar batten) depends upon where your obstruction actually is. It is not unusual to have some narrowing of the nasal cavity during or after rhinoplasty that may require the addition of the grafts described. Your surgeon will be able to tell you what you need. Whenever you get conflicting recommendations, you may need to see a third (or... more

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Spreader Grafts vs. Batten Grafts

MissLouise, Spreader grafts are for internal valve obstruction/collapse and batten grafts are more for external valve collapse. It is difficult to tell from the photo somewhat, but it appears to me that you have cephalically positioned lateral crura. This means the cartilage that supports the sidewalls of the nose (the area above the nostril rim), is angled upward too much . This causes lack of support to the lateral wall. This is why you have subtle shadows... more

Breathing Problems: Spreader Graft or Alar Batten Grafts?

In general, spreader grafts improve the internal valve and alar batten grafts improve the external valve. Although your photograph does not show the dynamic motion of your valve region when you breathe in, I suspect the problem is the external valve, and so the batten graft may be more appropriate.

Breathing Problems post Rhinoplasty

You do have vertically oriented tip cartilages which no longer support your external nasal valve. this will be improved with alar grafts. Spreader grafts will open your internal valves . These grafts along with correcting your septal deviation will improve shape and function.

Richard W. Fleming, MD

10 reviews

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Revision Rhinoplasty

If the external valve is collapsed, then alar grafts. If the internal valve is collapsed then spreader graft. If both are collapsed then both grafts.

Grafts for nasal breathing issues

It is hard to say what would be best for your without an exam. If you have midvault collapse then perhaps a spreader graft may be helpful. If you have external valve collapse an alar batten graft may be helpful. An exam would clarify things.

Steven Wallach, MD

13 reviews

Manhattan Plastic Surgeon

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