Breathing Problems: Spreader Graft or Alar Batten Grafts?

Question

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?

Thomas A. Lamperti, MD · Answer

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 actually a more powerful and anatomic procedure that gives very good functional and aesthetic results. Besides stregnthening the nasal sidewall it also creates more natural contours to the nasal tip. LLC repositioning is a much more complex procedure that not all rhinoplasty surgeons perform.

Sam Naficy, MD, FACS · Answer

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.

Anand D. Patel, MD · Answer

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.

Matthew Bridges, MD, FACS · Answer

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 between the tip and nostrils.  Battens can correct this functionally.  However, alar repositioning, usually with a supporting graft called a lateral crural strut graft, can correct the fundamental problem while improving form and function. 

	Just my two cents.  Good luck...

	Dr. Bridges

Samir Shureih, MD · Answer

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.

Breathing Problems: Spreader Graft or Alar Batten Grafts?

Answers (8)

Answer: Spreader Grafts vs. Batten Grafts

Answer: Spreader Grafts vs. Batten Grafts

Answer: Revision Rhinoplasty

Answer: Revision Rhinoplasty

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Breathing Problems: Spreader Graft or Alar Batten Grafts?

Answers (8)

Answer: Spreader Grafts vs. Batten Grafts

Answer: Spreader Grafts vs. Batten Grafts

Answer: Revision Rhinoplasty

Answer: Revision Rhinoplasty

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.