Bulbous Tip and Spreader Graft

If you narrow a bulbous tip and the nostrils, you may encounter nasal obstruction (afterwards), but that could fixed by a spreader graft. I read a spreader graft widens the middle vault. However placement of this graft pushes the side of the nose outward as well. I'm concerned the spreader graft makes my tip wider, while I want my tip narrower actually. Could there be a solution?

Doctor Answers 15

Role of spreader grafts and their effect on nasal tip shape.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello Cindarell. 

Standard spreader grafts are placed between the dorsal edge of the septum and each of the right and left upper lateral cartilages.  They function to improve the airway by opening the internal nasal valve formed by the junction of each upper lateral cartilage and the septum.  They also shape and stablize the roof of the middle vault.  Depending on the width of the spreader graft they can significantly increase the width across the dorsum of the middle vault.  Standard grafts typically do not extent to the level of the lower later cartilages and therefore should not widen the nasal tip.  Extended spreader grafts are longer and can potentially widen the nasal tip, however they are typically used in revision rhinoplasty cases to aid in lengthening the nose.

Narrowing the nasal tip in most cases does not markedly reduce the cross-sectional area of the nostrils and therefore should not cause nasal obstruction.

Sincerely, Mario J. Imola, MD, DDS

Denver Facial Plastic Surgeon
4.9 out of 5 stars 125 reviews

Bulbous tip and spreader graft

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The tip techniques used to reduce the bulbous tip involve removal of tip cartilage and sewing the tip cartilage together to reduce the bulbosity of the nasal tip.  With regards to the midthird of the nose, spreader grafts are used to widen the midthird nasal vault.  The spreader graft only widens the nasal tip minimally.  In that instance, a spreader graft can be placed more superiorly so as not to widen the tip very much if at all.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Spreader grafts make the tip wider

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

  Yes, you are correct that spreader grafts widen the nasal tip and IMHO, they are way over used.  Just because the nasal tip is narrowed, this does not mean the internal nasal valve is weakened to the point of creating decreased breathing.  In fact, in my over 20 years of performing Rhinoplasty, I have seen far more problems in nasal airway reduction created by improperly closed intracartilagenous (IC) incisions after a Rhinoplasty (performed elsewhere) resulting in internal mucosal web formation that any other issue.  I close all IC incisions completely and do not get Rhinoplastty patients complaining of nasal collapse and do not use or recommend spreader graft placement.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Spreader graft

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If spreader grafts are necessary they are mean't prevent excess narrowing and collapse of the middle third of the nose and protect the airway. The plan for their use should be integrated into the plan for the tip and be complementary to it so everything flows.

It's good to try and find out as much as you can about techniques used but important to remember that online searches don't give you the context of surgical training and experience. I find it best to review the desired outcome of the rhinoplasty with my patients and not get too bogged down in all the steps it will take to achieve this result.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Cartilage Grafts in Rhinoplasty (Nose job): Spreader grafts and Tip grafts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Cartilage grafts can be utilized to improve both the function and the appearance of the nose. They can be harvested from the septum, ear and rib. There are also absorbable materials which can take their place, especially in grafts used for structure and support, such as a spreader graft. Spreader grafts help to increase the angle of the internal valve, as well it can help straighten the nose. Extended spreader grafts travel to the caudal septum and can lengthen the nose. Standard spreader grafts if placed properly should have no effect on the tip and have minimal relation to a bulbous tip. These grafts can widen the dorsum or middle segment of the nose, but should be relatively hidden. Correcting a bulbous tip involves changing the angle of the tip or dome. This can be done with sutures and tip grafts. I think you are confused with the use of the grafts and their nomenclature. You may be thinking of a lateral crural strut graft. Anyways, leave this to your board certified plastic surgeon who performs rhinoplasty.


Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

Bulbous tip and spreader grafts.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Properly done the tip can be narrowed and the spreader grafts done (if needed) and your nose will look natural.,

The key is not HOW it is done, but WHO is doing it!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Bulbous Tip and Spreader Graft

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Narrowing a bulbous tip can cause nasal obstruction but this should be avoided. A spreader graft is placed in the middle 1/3rd of the nose, will improve airflow above the tip, and will not widen the tip. A large spreader graft can widen the nasal wall above the tip, but this too can usually be avoided. During consultation your surgeon will explain all of this and establish reasonable expeectations.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Bulbous Tip

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If the spreader graft is placed correctly, the tip will not be made wider. It does, however, slightly widen the middle 1/3 of the nose. This widening is only to the extent that it fixes the depressed/collapsed area.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 96 reviews

Improving bulbous tip without spreader grafts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Spreader grafts don't address (or affect) the tip itself. Spreader grafts improve the narrowness of the middle third of the nose.

Tip bulbosity can be address using other maneuvers, however, depending on the precise cause. Techniques can be used that help to ensure normal breathing ability after surgery as well.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Spreader grafts typically do not widen the tip of the nose

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Spreader grafts are used to:

  1. Increase a narrowed portion of the middle portion of the nose to improve breathing and appearance.
  2. Straighten a crooked nose.

Spreader grafts will not:

  1. Widen the tip as they are not placed in the tip of the nose.
  2. With one exception- if extended spreader grafts are placed to lengthen an overly shortened nose the tip can appear more bulbous.  This will be more visible over the first few months due to swelling and will subside where it is almost not perceptible.  Please discuss this with your surgeon.

Good luck with your surgery


Ran Y. Rubinstein, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 158 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.