Breathing Problems: Spreader Graft or Alar Batten Grafts?

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.

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.

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.

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

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.

It is hard to say what would be best for your without an exam.  If you have midvault collapse then perhaps a spreader graft may be helpful. If you have external valve collapse an alar batten graft may be helpful.  An exam would clarify things.

You do have vertically oriented tip cartilages which no longer support your external nasal valve. this will be improved with alar grafts. Spreader grafts will open your internal valves . These grafts along with correcting your septal deviation will improve shape and function.  

Either graft may be useful to open the nasal cavity to allow easier breathing.  Whether you need grafts inside (spreader) or outside (alar batten) depends upon where your obstruction actually is.  It is not unusual to have some narrowing of the nasal cavity during or after rhinoplasty that may require the addition of the grafts described.  Your surgeon will be able to tell you what you need.  Whenever you get conflicting recommendations, you may need to see a third (or more) surgeons to get a consensus.  Be sure you are seeing surgeons who have experience with rhinoplasty revisions and the correction of obstruction.