Is an alar batten graft enough? Can spreader grafts be visible on some noses?

Hi Emily,There are variations on the surgical techniques and grafts each surgeon uses.  Some of the terms can be confusing. -Spreader grafts help improve breathing by opening the internal nasal valve in the middle of the bridge of your nose. They add some width to the bridge of the nose, but we are talking about 1 to 2 mm and it is usually not noticeable.  -Batten grafts help improve breathing by opening the nostril (both internal and external nasal valves are improved) and typically go from the nasal tip all the way to the cheek. Batten grafts can add width to the side of the nasal tip. Another available graft is the lateral crural strut. Lateral crural strut grafts go from the nasal tip to the cheek as well, but it is placed under your native cartilages (while the batten graft seats on top your cartilage) making the risk of visibility lower.  I understand you want to breath better and try to minimize the chances of visibility of any of the grafts or making your nose look bigger or operated upon. Makes sense!Seek other consultations with rhinoplasty surgeons and get more opinions until you feel like you have a good connection with a surgeon.Hope this helps!

 Revision rhinoplasty with cartilage grafting techniques is a very difficult endeavor, so an in-person consultation and thorough examination of the internal and external nose at rest and with inspiration is required.  It is very rare that a spreader graft or  batten grafts would show through the skin, since they are  placed underneath the  skin and the upper lateral or lower lateral cartilages. More importantly, is to know how much cartilage is left on the inside of the nose for grafting purposes after the previous septoplasty. For more information about spreader grafts and many examples, please see the link below

Hello Emily19583,Opinions regarding the best method or technique will vary from surgeon to surgeon. In many cases, patients require a combination of techniques. As for spreader grafts, it really depends on the size of the spreader grafts. It can give extra width over the middle section of your nose, but usually this is negligible. Alar batten grafts can also increase volume in the area above the top part of your nostril where it meets the cheeks. One thing that is somewhat apparent to my eye from the single picture you posted is that you have a very narrow tip. This could be contributing to your flow issues. In that case, there are additional techniques that can smooth out the transition from the middle of the tip to the side of the tip so that it doesn't collapse.In any case, there will be a tradeoff between aesthetics and function in your case, so you should go to a surgeon that does a fair amount of both types of nasal surgery cases.Have a nice day,Michael M. Kim, MD

Hello Emily,It is impossible to tell you exactly what needs to be done without a proper examination of your nose. It sounds like you are having functional issues with your breathing secondary to a dynamic collapse of your external nasal valves and you likely have some internal valve issues. The photo you posted shows some asymmetry of your nasal alae .Spreader grafts are "invisible" structural grafts that help open up the angle of the internal nasal valve, when properly placed, they should not be visible. Alar batten grafts and lateral alar struts will change the shape and/or position of the nasal ala and can be "visible" in some cases.I would venture to say that you probably will need a combination of both in order to correct your problem. I hope this helps.