What are the risks of bilateral spreader grafts (lateral wall) & how do I know if I need them in revision?

Question

Yrs ago had a good rhinoplasty ear cartilage in dorsum & alloplastic columellar/bilateral strut. Unfortunately, dorsum was pulled/hit in assault--no bones broken. In bad attempt to revise injured nose, a new surgeon removed ear cartilage & implant, lowering dorsum, replacing ear w/ unsupportive tip graft. Skin/scar now sagging down on bones. I consider the revision botched. Given that my bones were never broken, can I revise this by replacing dorsum/rotating nasal tip up to relieve headaches?

Alejandro Nogueira, MD · Answer

It would be helpful you could post a varied set of clear images of your present situatio, so that we could give you good guidelines and advice.Your case is, anyhow, a challenging one due to the multpiple rhinoplasties received; you must know that the nose has a biological limit, from which the skin fails to adapt and becomes sclerotic and allows no more operations; you could be near that limit, so for the LAST rhinoplasty find a very very good revision surgery doctor who can finally obtain the nose you wish or the closest technically possible to it. It could be your last bullet.

Afshin Parhiscar, MD · Answer

Dear anonpatientIn general, spreader grafts are used to create support for breathing (internal valve) and sometimes to help achieve extra support/straightening of dorsum. In general, bony fractures are not directly relevant in their use.From the last line in above, I'm guessing you want this surgery to help you with headaches as well.Headaches from trauma are unlikely to change with this type of surgery unless your headaches are secondary to nasal obstruction and  apnea secondary to that ... It sounds like you would benefit from revision surgery but use of spreader grafts and relief of headaches may or may not be addressed in your surgery.You should have a consultation with 2 or 3 board certified Plastic ( or Facial Plastic ) surgeons and try to get all the info you need for an educated decision.

William Portuese, MD · Answer

Spreader grafts are placed underneath a concave upper lateral cartilage in the mid vault area of the nose. If the middle portion of the nose is concave on either one or both sides, a spreader graft is composed of the patient's own cartilage from the nose or from the ear, fashioned and placed underneath the concave upper lateral cartilage. For  diagrams, please see the video below

Francis R. Palmer, III, MD (retired) · Answer

In my opinion, spreader grafts are over used in Rhinoplasty.  They add volume and as such increase the width of the nasal tip which patients often find unattractive.  They may be required in severe cases of internal valve collapse but in my experience that is quite rare.  You can replace the dorsal graft and rotate the nasal tip but this may or may not relieve any headaches that you are experiencing.  You might want to see an ENT surgeon to rule out sinus disease as a cause of these headaches.

What are the risks of bilateral spreader grafts (lateral wall) & how do I know if I need them in revision?

Answers (4)

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