Auto-spreader technique Vs. Spreader grafts

In order to do auto-spreaders, a patient needs to have very tall and clean upper lateral cartilages. This is typically not available in every patient; that makes spreaders more reliable. More over, using the septum, the surgeon can control the thickness and length of the spreaders with more ease than ULCs.

The auto-spreader graft is more commonly performed on primary and reductive rhinoplasty where excess upper lateral cartilage may be available. In secondary or revision rhinoplasty where the upper lateral cartilage is scarred or already reduced an auto spreader graft is not possible and the septum or other donor cartilage must be used.hope that helps!

This depends upon the technique preferred by your surgeon and your anatomy. Both techniques work well in properly selected patients. Good luck! I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Hello,This is a highly technical question, and you have the right to know, but when a patient starts to micromanage their upcoming surgery, their lack of real surgical experience and understanding can get in the way of making good decisions.Auto spreader grafts are the ideal graft if it can be done; it avoids having to harvest cartilage from another location. There needs to be enough cartilage to 'turnover' and re-attach to the septum to make it worth while, though. I find that I am wanting a thicker, more robust graft frequently, so I turn to septal cartilage.  Harvesting septal cartilage usually does not cause extra trauma, effort, or time, because the septum is frequently deviated and submucous dissection and cartilage removal needs to be performed to straighten the septum anyway. Best of luck!

I think this is an excellent question. The problem with internal valve collapse is the outer wall approaches the midline septum on one or both sides of the nose on inhaling and occasionally in repose. The surgical answer is to place a narrow piece of cartilage between the sidewall cartilage and the midline septum cartilage hence the term spreader graft. That cartilage was classicaly obtained by harvesting the cartilage from the septum, ears or ribs. In 1992 a surgeon proposed folding that sidewall cartilage as an autograft between the midline septum cartilage and itself as an autograft. The main problem in doing so is that it lowers the cartilage portion of the bridge and may be contraindicated if you do not have a hump that is taken down at the time of surgery. Other issues are it has to be done open to get the necessary exposure and requires more dissection susceptible to button holing the mucosa in order to get it to fold. Inserting a classical spreader graft can be done closed and gives the surgeon more options as to the size and type of cartilage used.I would not recommend choosing a surgeon based solely on which type of spreader graft they use. I am sure there are patients who could benefit equally from either approach as well as those who could benefit from one more than the other.I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

The difference between auto spreader grafts and spreader grafts ? Both  methods have their advantages and disadvantages. Pick the surgeon who has noses that you like and don't worry about what type of spreader graphs he uses. Choose the surgeon who does noses you like the best and not the technique.

 Thank you for your question. Both techniques achieve similar results. However with spreader grafts, a surgeon has more control in regards to straightening out nasal septum and proving support. Also, auto-spreader graft quality is limited by the height of the upper lateral cartilage as well as patient's anatomy.  it's always best to have a thorough discussion with your board-certified plastic surgeon prior to your scheduled proceed. Best of luck.Dr. Dhaval Patel 

 Both techniques have merit and can be used effectively in the right hands. The determinant of the result is not so much the technique, but the experience and judgment of the operator and the skill with which the technique is applied. Additionally, some pat may not have the right anatomy for the Auto spreaders. 

Thanks for your question,This is an area where I have considerable interest as I do research in nasal valve collapse. It is a complicated and controversial answer to your question. Many surgeons will swear by their technique, however in the end both have benefits and weaknesses.  I use standard spreader grafts as I feel I have more control over the amount of "spread" I can achieve. As mentioned below, you need tall lateral cartilages to do an autospreader, so in some people it is not possible. Regardless of the technique, they both achieve a similar result. Dr James Bonaparte

Thank you for your question.I think of all the questions i have seen on this forum, yours is really the best. When I started out, I was using spreader grafts in everyone. I have also done extensive research on spreader grafts when I was a fellow at the Cleveland Clinic in Ohio. Some of the research is published in October 2015 PRS.I then bought Dr Cerkes's video on rhinoplasty from QMP and he beautifully demonstrates how to perform an auto-spreader in the videos. Since that time, I have switched over to using auto-spreaders.I must say I find auto-spreaders much easier to perform, they save at least 30 minutes in the procedure, the cartilage on the upper lateral cartilages are thin compared to that found in the septum so you do not face the problem of creating a boxy looking nose when you use thick cartilage from the septum. Auto-speaders also give a very natural looking nasal profile. Everyone has good cartilage on the upper laterals. You just have to peel off the overlying musculature to expose it.Hope my answer helps.Ivo