I want a smaller, less projected, more refined nose and tip. Do I need grafts? (Photo)

I have been 3 consults,all agree to a septorhino.Shave hump,work to tip to less bulbous and nose to be less projected.Problem I have is 2 surgeons recommend spreader grafts as I have slight obstruction to right airway and they believe nose too thin in middle portion.And graft to tip to prevent droop.Will grafts provide definition&symmetry?Nose does go to one side on front view and I want it more symmetrical and the tip&middle have much more definition like last pic.Are grafts needed for this?

Doctor Answers 13

Spreader grafts

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Thanks for your question. It is a pretty sophisticated question, but important. Spreader grafts are commonly used to both improve function and symmetry in the middle third of the nose. Judging from the photos you posted I would agree with the observation that your middle third is very narrow and this is likely having a negative impact on your breathing. The typical tradeoff for placing a spreader graft is making that area slightly wider, but in your case I also think that is a benefit aesthetically. It sounds as if you have been getting very good advice, In my opinion you should pick the surgeon that you feel most comfortable with and go for it, chances are overwhelmingly in your favor for a great result with a well credentialed, experienced rhinoplasty surgeon. Hope this helps. 

Chicago Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

I want a smaller, less projected, more refined nose and tip. Do I need grafts?

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Thank you for your question and photos. There are different kinds of rhinoplasty operations however we can divide them as the one that requires bone excision and the one that does not need bone excision. The main fact that we classify the rhinoplasty operations like that is that the results and postoperative period is associated closely with this fact. In the operations like “nasal tip correction”, “simple rhinoplasty” there is no need for a bone excision however these minor operations cannot be beneficial for everyone. The operation type is need to be determined by the surgeon according to needs of the patient. In these minor operations the rhinoplasty is performed with closed method. The bone and the cartilage tissues are not involved in the surgery directly. Small nasal bumps can be removed in these operations.

Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.8 out of 5 stars 102 reviews

Spreaders a good idea

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It sounds like the spreader grafts would be a good idea, being that you have some obstruction on one side. They will provide more symmetry to the dorsal aesthetic lines, but will not add more to the tip.

Marcelo Ghersi, MD
Miami Plastic Surgeon
5.0 out of 5 stars 154 reviews

Septoplasty and rhinoplasty with spreader grafts

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 When patients have an hourglass deformity from the frontal view and have a very thin nose, and they usually require  spreader graft placement. The spreader grafts not only widen the midportion of the nose, but also can improve the airway. To prevent the tip of the nose from drooping when smiling  requires releasing the depressor septi ligament. For many examples  and more information, please see the link and video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Even in reduction primary rhinoplasty grafts are often necessary for balance and airway

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In the vast majority of rhinoplasties, even primary reduction surgery, I almost always use some grafts. Removing a large hump can compromise the internal nasal valve, which is the middle third of the nose. Your nose won't look appreciably wider, but it will likely work and look better with at least some grafting.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Narrow middle third of the nose

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Spreader grafts worked very well for narrow nose in its middle third.  It improves appearance but also improve the breathing in any obstructed area.

However, there are many different techniques available to improve the anesthetic outcome of the nose without using spreader grafts as well.  It's more important for you to proceed with the surgeon you feel the most comfortable with.


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews


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What techniques your surgeon proposes are done after an examination, history and a discussion of your desires. Different surgeons have different skills and different approaches to the same problem. You have to be comfortable with the surgeon, his explanations and results.
Your photo does show a very narrow midvault. This is usually corrected by spreader grafts. Tip grafts  (Sheen type) are most commonly used for tip projection, definition, symmetry and not droop.

Dennis Barek, MD (retired)
Great Neck Plastic Surgeon


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Every surgeon is different and uses different maneuvers to achieve the goals of a balanced nose and hopefully a happy patient.  Best of luck with your decision to move forward.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Don't focus on technique, focus on the surgeon for #rhinoplasty

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Without seeing you and feeling your nose its not useful to make comments online but from the look of your pictures you have fairly thin skin and fairly weak cartilages and short nasal bones (just based on these pictures).  
You also have a very narrow bridge with asymmetries.  To get the nose to be smaller, cuter, more symmetric and better a variety of structural techniques may need to be used including various sutures and grafts.  It just depends.  You may not truly need a spreader graft if the surgeon can use your own Upper Lateral Cartilages and leave them higher and stronger.  Same thing for the tip.  You may need a columellar strut but if a Tongue in Groove is done then you may not need the strut.  Again just depends.  These are just tools.  The thing you should focus on is finding the best possible surgeon and trust his judgement.  10 surgeons may list the techniques and tools they want to use but your task is to find the one who uses the tools the best.  

Shervin Naderi, MD, FACS
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 119 reviews

I want a smaller, less projected, more refined nose and tip. Do I need grafts? (Photo)

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Always better to follow in person recommendations than our over the internet guesses! Especially if 2 surgeon essentially say the same thing... 

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.