Spreader graft question

Heys docs during a closed rhinoplasty is it common to use a spreader graft or a spreader graft is only really associated with open rhinoplasty I am just very confused. Or does it not matter and a spreader graft just has to do with a hump removal and independent of either approach? Can it be placed closed or not really and how does one know during a closed procedure?

Doctor Answers 11

Spreader Grafts

Hello,

It is not true that 'it makes no difference' whether spreader grafts are placed via an open or close procedure. Virtually everyone who places spreader through a closed procedure does so without suture fixation. I adhere to the philosophy of a thoughtful surgeon who just retired, John Tebbits. He believed and wrote in his book that rhinoplasty is too difficult to perform consistently and successfully without every possible advantage the surgeon could use. Open rhinoplasty affords that advantage, so that accurate and secure placement of grafts can be made, every time. 

Best of luck!


Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Spreader grafts

Spreader grafts are probably more commonly placed through an open or external rhinoplasty approach. However, they can also be placed through a closed or endonasal approach, as well. I think that placement through an external approach allows for more precision in placement, but there are certainly many surgeons who would argue that this concern is trivial and does not affect the result.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Spreader grafts and grafts in general for rhinoplasty can be confusing

Dear adam1992

thank you for the question

  • the type of approach (open or closed) doesnt influence whether a graft is used; 
  • spreader grafts and others are commonly used in closed or open rhinoplasty
  • consider the goals that you are seeking and balance those with what your surgeon says is possible- then the graft choices and surgical procedure can be tailored to you by your surgeon.
  • basically, a spreader graft is a cartilage taken from your septum, ear, or rib that is shaped and placed between the septum of your nose and the shield like cartilage called the upper lateral cartilages. 
  • They can have both functional and aesthetic uses. 

Best Wishes and of course discuss with your surgeon in a face to face meeting.

Travis T. Tollefson, MD, MPH
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Everything you've ever wanted to know about Spreader Grafts

Ok....

So spreader grafts are small pieces of cartilage (usually taken from the septum during septoplasty - when fixing the breathing) and stitched in place in the INTERNAL NASAL VALVE area of the nose.  They help increase the angle of the internal nasal valve, thereby increasing airflow in this region.  

Spreader grafts can be placed by the open or the closed approach.  It is very simple and straightforward to place these with the closed approach and it is NOT necessary to do open rhinoplasty just to place spreader grafts. 

Spreader grafts are placed if the valve area is weak causing breathing issues, or if the valve area is weak and causes a cosmetic pinch of the mid-third of the nose (which can naturally occur before surgery or can occur during the surgery after the hump/bump is taken down on the dorsum of the nose - at which point your surgeon would likely elect to place spreaders to help prevent a mid-third pinch).


All the best!

Deepak Raj Dugar, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews

Spreader graft placement during rhinoplasty

Spreader grafts can be placed via open or closed rhinoplasty approaches. I find that the open approach allows for more precise placement of spreader grafts and allows for better suture fixation of the grafts, but that's my personal preference. An experienced surgeon will use the approach he or she is most comfortable with and either approach--open or closed--is acceptable.


All the best,


--DCP

Pearson Facial Plastic Surgery®

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Use of and Placement of Spreader Grafts

Spreader grafts can be placed using the open or closed approach.  Experienced surgeons do not elect to use the open approach just because spreader grafts will be used.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Spreader graft placement with closed rhinoplasty

In our practice, it is common to perform spreader graft placement with Closed rhinoplasty. Spreader grafts are placed for patients who have a concave upper lateral cartilage, or who have a very weak upper lateral cartilages after the dorsal hump removal to prevent a collapse in that area. Spreader grafts can be placed through either an open or closed approach. For more information in many  before-and-after examples of spreader grafts, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Spreader grafts

Spreader grafts can be placed through the open approach, but endonasal spreaders can also be placed.  The placement is slightly different through the closed approach, but have the same effect.  An experience surgeon will do what is most appropriate for each situation.

Spreader grafts are used to stabalize the middle vault and the prevent collapse of the internal valve.  This is often needed in a hump removal, or anytime a patient has a narrow valve. Many surgeons place them in every case where the upper lateral cartilages are displaced to prevent collapse of the valve in future years.

Best of luck

Dr Rodman


Regina Rodman, MD
Houston Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Use of spreader grafts.

Spreader grafts can be inserted during either a closed or open rhinoplasty and are felt to be necessary when a dorsal hump is reduced or in patients who have inspiratory collapse and nasal obstruction before surgery.  We use them either prophylactically to prevent obstruction while narrowing the nose or to treat narrow "internal nasal valves."  Thanks for your question.   It's a little technical but a good one.

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca 

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Spreader grafts--open or closed rhinoplasty?

Spreader grafts--open or closed rhinoplasty? It makes no difference to an experienced rhinoplasty surgeon which approach. Choose a rhinoplasty surgeon who does natural noses with either technique.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 32 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.