Is a Spreader Graft Necessary to Fix Nasal Valve Collapse?

The question you ask is simultaneously both simple and complicated. The essential truth is that both grafts will help with correction of a crooked nose and both will help with functional problems. However, there are subtle differences between the 2 options.

Difference #1: Approach

I do spreader grafts through a closed approach typically, but many surgeons will only place them using an open approach. If an open approach seems like too much surgery for a single graft, then many surgeons will use an onlay graft instead, which can always be done closed and is technically much simpler.

Difference # 2: Airway affect

If your nasal sidwall collapses when you inspire, then too much cartilage was removed at the first surgery and you probably need an onlay graft more than a spreader graft. A spreader graft will lift and support the cartilage but not strengthen it.  An onlay graft will add strength to the underlying cartilage that is weak by helping to stiffen the sidewall. Conversely, if your valve is narrow but not collapsing, a spreader graft is a better choice becuase it actually lateralizes the canopy cartilage, opening up the airway. In more extreme deviations with collapse, I will often use both a spreader and an onlay.

Difference # 3: Cosmetic effect

A spreader graft will give more subtle deviation correction and it tends to add width only paradorsally (that is closer to the center of the profile). I personally like this cosmetic effect more than the effect you see with onlay grafts. Onlay grafts add width in the entire nasal sidewall, which results in a slightly wider looking nose with less shadow contrast. However, for more extreme nasal deviations, onlay grafts give bigger corrections and are a little more predictable. Again, sometimes I will use both in a single patient.

 

Besides these differences, there are other technical ones that are less important, such as donor cartilage availability and swelling after surgery. All in all, neither is a bad choice. If you are using a reputable surgeon with a good track record of success, then follow their suggestion, as it is probably based on their impression from your examination.

Best of luck

Spreader grafts are grafts from septal cartilage or less commonly ear or rib cartilage which are placed between the upper lateral cartilage and the septum to widen the nasal valve.   This can improve breathing and also widen this area if there is a visible depression.   Spreader grafts can also help to straighten a crooked septum that has a high deviation and make the nose  straighter.   Alar batten grafts are grafts placed under the lateral crura to add more rigidity to this area if it is weakened (by surgery or naturally) and prevent collapse with inspiration.   Perhaps your surgeon is referring to this approach to fixing your nasal valve.  Most would agree the open approach is preferred in revision rhinoplasty but many surgeons also perform revisions closed.   It sounds like you need to have another discussion with your surgeon to get some of your questions answered. 

Spreader grafts may be harvested from nasal septal cartilage and are useful for both functional and aesthetic nasal concerns. These small pieces of cartilage may be 10 x 3 mm, and are typically sutured to the top of your septum to move your upper lateral cartilage outward - this may lead to a straighter nasal appearance and improved breathing. Hope this helps. Dr Joseph