Rhino Revision to Insert Spreader Graft for Collapsed Mid-dorsal?

I had rhino ~5 years ago. Returned 4 mos post-op because it felt "pinched" & I couldn't breathe. Now, I constantly wear breathe-right strips. Doc says I need to have a spreader graft inserted because I have a collapsed mid dorsal(?) I love the way it LOOKS, I just can't breathe! I worry that a revision will look bad or crooked. How long is the recovery? Can I expect the same level of swelling/etc as the first rhino? Will the graft help me breathe? Or should I just live with it?

Doctor Answers (10)

Revision Rhino Spreader Grafts

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Additional views would be helpful to give you a more specific analysis.  From the single photograph, it appears that you have at least mid-vault collapse and possible mild saddle collapse.  I would recommend spreader grafts to help improve your breathing, reinforce the mid-vault and improve the cosmetic profile.  I would recommend that you consider the surgery as the problem will probably progress.


Newport Beach Plastic Surgeon
4.5 out of 5 stars 9 reviews

Functional revision

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You will likely benefit both functionally and cosmetically from a dorsal graft as well as possible alar strut grafts - posting other views would be helpful

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 132 reviews

Rhino Revision to Insert Spreader Graft for Collapsed Mid-dorsal?

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Revision rhinoplasty is usually associated with a more prolonged recovery, however, in my mind it is worth it if it results in improved nasal breathing. Personally, I prefer a straight to slightly concave nasal bridge, and so in addition to spreader grafts to resupport the middle third of the nose, you may also benefit from a dorsal onlay graft to produce a more natural profile. Good luck!

Anand D. Patel, MD
Austin Facial Plastic Surgeon

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Revision rhinoplasty with spreader grafts to restore normal breathing

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Spreader grafts are used to bolster the sidewalls of the nose, not the dorsum. Spreader grafts are used to spread the upper lateral cartilages outwards and laterally. Cartilage grafts are used to build up the bridge of the nose. Rasping is done to remove any bony irregularities and osteotomies are performed to narrow the nasal bones. A septoplasty and turbinate surgery can also be performed to improve airflow dynamics through the nose. Revision rhinoplasty is very difficult and takes a full year for healing. Recovery time after the surgery is approximately ten days with some degree of bruising and swelling. Do not expect to breathe well out of your nose in the first week after the procedure has been performed.

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Spreader Grafts to Improve Breathing

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Spreader grafts of cartilage taken from your septum or ear will improve your breathing, especially if your obstruction is relieved with the use of breathe-right strips. If there is a change in your appearance, it will be minimal. Swelling will be significantly less than what you experienced with the original surgery and the initial recovery will take 7-10 days.

Richard W. Fleming, MD
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Spreader grafts for correcting nasal valve collapse

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Spreader grafting to correct collapse of the middle third of the nose and to improve nasal airway obstruction is a very effective technique. That being said it is possible that it will widen the middle third of the nose; however, most of the time that is necessary and also adds aesthetic balance to the middle nose region. I hope this information helps. I would discuss with your surgeon as to how much widening of the middle of the nose might be expected and this should help your decision making process.

Scott Trimas, MD
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Spreader grafts help internal valve collapse

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The risk of reduction rhinoplasty is always nasal airway obstruction, as a balance exists between making the nose smaller and losing necessary support altogether.  You experienced this with your first surgery.

Function trumps form.  You should be able to breath first and foremost.  So some form of revision surgery is suggested, and most docs would employ spreader grafts and/or other manipulation of the mid third structures.  The amount of added volume is subtle, and tends to improve the balance of the nose instead of detract.  Your nasal lines are likely to look more natural in the process, so you don't have to anticipate the appearance of a big amorphous nose in the process.

Kevin Robertson, MD
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Spreader grafts

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Spreader grafts are place in the midvault to open the airway and allow the patient to breather. It should help.

Steven Wallach, MD
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Spreader cartilage grafts for difficulty with nasal breathing

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Spreader grafts will tend to provide the best solution for the collapsed mid- vault. However, it may may the nose appear slightly wider from the frontal view.

Otto Joseph Placik, MD
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Cartilage grafts are one of the best ways to restore breathing after failed rhinoplasty

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Spreader grafts are the most common cartilage grafts used to restore breathing when the middle third of the nose collapses on breathing. The best source for these grafts are cartilage from your own nasal septum. If that cartilage has been used or treated by Septoplasty then ear or rib cartilage may be used. The cosmetic changes usually make the nose look even better as well. I like to quote the Bauhaus: form follows function.

Steven J. Pearlman, MD
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.