Is It Absolutely Necessary to Put a Spreader Graft in to Imporve Breathing?

Breathing is much more a function of the internal nasal structures rather than the external ones that have more to do with nasal appearance. The internal nasal valve is "overrated" as a functional structure, in my humble opinion, and widening it via spreader grafts is, in my experience, less helpful than restoring the septum to mid-line (if necessary), and opening the airway appropriately by partial inferior turbinectomy/turbinoplasty.

I have operated on many patients who have had failed one (or sometimes more) breathing operations (after septoplasty only, after spreader graft placement, or after septorhinoplasty), and have corrected their airway problems with septal centralizing and partial inferior turbinectomy/turbinoplasty.

Though I have no specific "beef" against spreader grafts, I use these only when the nose is excessively narrow and would be improved cosmetically by widening. Otherwise, I prefer to make the appropriate and desired cosmetic changes in the nose first, followed by the septal and turbinate work to maintain or improve the airway.

Thus, you do NOT have to have spreader grafts to breathe properly, and can still obtain the desired cosmetic appearance!

Dear Rhinoplasty patient from Illinois,
Due to the complex nature of the nose, swelling may take several months to resolve after a rhinoplasty. Most swelling resolves after two weeks. It is important to know that due to swelling there is significant internal and external swelling. This swelling may causes nasal obstruction as well as widening of the nose. If you just had your surgery, this is very normal healing process of nasal surgery. However if this is more than two months you need to talk to your surgeon for guidance. Good luck and good healing
 

If someone has septal deviation or large turbinates as the cause of the breathing problem, spreader grafts won't help. They are used to open the "valve" area and will make the nose slightly wider. Ask your surgeon and if you are not happy see an experienced revision rhinoplasty specialist. 

Spreader grafts by themselves do not insure and improved airway. They must be utilized appropriately. The key issue is whether the spreader graft is appropriate for the nasal airway at hand, AND, does it open the nasal valve as designed. 

Spreader grafts are used quite commonly for airwqy difficulty thought to be due to airway collapse. They can also help keep seotum straight.  If there are other causes for airway difficulty they have to be investigated and potentially treated.

Spreader grafts are placed to improve breathing in the internal nasal valve, the narrowest area of the nasal airway. If you still have airway symptoms months after surgery, it is important to search for its cause(s). A detailed history and nasal exam may uncover an issue related to an anatomic issue like enlarged turbinates,nasal polyps,adhesions,displaced spreader grafts, septal deviation, or external nasal valve obstruction. You may have unrecognized sinus disease or vasomotor or allergic rhinitis. I would avoid rushing into another surgery until you have investigated these issues. Spreader grafts do widen the middle third of the nose as this is what in part they are destined to accomplish.

There are numerous factors that contribute to a good airway and each of these must be addressed in a rhinoplasty or septoplasty for a successful result.  A spreader graft will open up the internal nasal valve but also may widen the appearance of the middle third of the nose. Usually this works together by straightening a depressed area of the nose while simultaneously improving your breathing.  If your graft "collapsed" then this may be working to make your airway worse.  If it descended, it can get in the way of air movement through the nose. Have a consultation with an experienced nasal surgeon in your area to help determine the cause.  You could have large turbinates, a deviated septum or even narrow of the external valve of the nose.

Best of luck

Vincent Marin, MD, FACS

San Diego Plastic Surgeon

It is quite normal for several months after surgery to have some airway obstruction.  There is also a fair amount of swelling after the surgery that takes time to get better.  If you are that unhappy with the result, go back to your doctor and discuss it with him.  If it is long enough time after surgery a revision may be in order.  Good luck on you decision.

Nothing is absolutely necessary in rhinoplasty surgery; there are always advantages and disadvantages of alternative techniques. You need to consult with your surgeon and/or get a second opinion.