Is there less cosmetic risk between removal of spreader graft or thinning of spreader grafts? why?

Question

what kind of cosmetic issues can occur with removal of spreader grafts that are making nasal bones/bridge appear wide? Assume no prior breathing problems And spreader grafts are not needed because they are causing unwanted cosmetic appearance of wideness

Afshin Parhiscar, MD · Answer

Dear empoweressI'm not sure if I clearly understand. If you had no breathing difficulty prior to your spreader graft, then why was it placed? if your surgeon placed it at the time of your rhinoplasty as  a preventive measure, then removing it may now lead to breathing difficulty. It is a matter of degrees and an experienced surgeon may be able to keep the spreader grafts while giving the appearance of a narrower dorsum. In general, the thinner the spreader graft, the less airway support.

Andrew S. Frankel, MD · Answer

Over the years I have removed many spreader grafts in order to create a more narrow middle third of the nose. Although the dissection required to do so can be extensive, the procedure is not very difficult or risky per se. The important question is why you feel they should be removed or thinned out? It is important to discuss the specifics with your surgeon before moving ahead with such a procedure to ensure that you will be happy with the outcome. As a result of removing them your three quarter view might show a slight 'bump" where there would be a step off between the end of the nasal bones and the upper lateral cartilages. The profile is usually unchanged and the middle third of your nose will look narrower. Breathing may or may not become worse. Of course, many of these things depend on just how wide the grafts were in the first place.

Erel Laufer, MD · Answer

In certain cases of rhinoplasty ,especially if the nasal bones are short, it is necessary to use spreader grafts in order to maintain airway patency. If their presence creates unaesthetic appearance to the nose by widening the bridge ,it is possible under certain conditions to thin them out.

William Portuese, MD · Answer

It is very difficult to thin or move spreader grafts without leaving a cosmetic defect and creating more of an issue. The spreader grafts are placed in a precise pocket underneath the upper lateral cartilage and are difficult to remove without damaging surrounding tissues. The spreader grafts do not make the nasal bones wider, only the upper lateral cartilages

Richard W. Fleming, MD (retired) · Answer

Risks always are influenced by the skill of the surgeon. When you ask about "cosmetic" risk I assume your talking about the appearance of the end result; do whatever is necessary.

Is there less cosmetic risk between removal of spreader graft or thinning of spreader grafts? why?

Answers (5)

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