Can Spreader Graft or Onlay Camouflage for Small Dent Be Performed Via Closed Rhinoplasty?

Based on your photos it appears that you can be helped by:


spreader grafts

camouflage onlay grafts

fillers

Indeed spreader grafts are performed through closed rhinoplasty whether it is a unilateral or bilateral problem.  It is not a good idea to put fillers in the nose due to the disastrous complications that have occurred.  Small dents are easily addressed through a small spreader graft harvested from the internal portion of the nose, which is then inserted up underneath the affected upper lateral cartilage to make the dent go from a concave indentation to normal convexity to better match the opposite side.  

Treating a crooked nose after injury is challenging sometimes- but there area some very effective, permanent treatments that I use frequently with great success. 

The best technique in my practice for a limited indentation of the middle nose is to fill the area using  a closed rhinoplasty technique.  A sculpted or crushed cartilage graft can work well.   For larger areas I often use a diced cartilage graft wrapped in temporal fascia ( a soft graft material taken from the scalp area).  This is a very effective method. 

I find fillers unpredictable in their longevity.

I save spreader grafts for treating breathing problems from a narrow nose. 

Remember- if the "dent" is truly small, maybe no treatment is a good option!

If you are happy with the rest of your nose, then fillers are the best option. Should be done by an experienced surgeon. All fillers work well including silikon which can be used as an off label, but only if done by someone familiar with these products.

You can have a spreader graft or an on-lay graft (which is what I think you need) through a closed approach. Actually the whole concept of spreader grafts came well before the acceptance of open techniques in rhinoplasty. A small on-lay will require a bit of septal cartilage to harvest as a fill for the dent, though this solution is far better than all the injectable filler material, and liquid silicone injections which are not FDA approved.
Best of luck,
peterejohnsonmd

The trauma you describe and resultant defect is called internal nasal valve collapse. Visually it looks like a pinching of the middle 1/3rd of your nose. 

External corrections can include, fillers, onlay grafts and spreader grafts. 

The problems of reduced breathing as part of this problem can only be corrected with spreader grafts.

All procedures can be performed through the closed approach.

You have several choices. The first is to leave it alone and not risk further deformity. The second would be to try an injectable filler. I would recommend Radiesse because it lasts longer than most fillers and is not permanent. The third choice would be a spreader graft. The risk being too much fill or another deformity.

 If you are happy with the rest of your nose and are only concerned with the samll dent, IMHO, I'd wait for up to 1 year after the trauma to see if the dent will fill in slightly with scar tissue.  An onlay piece of crushed cartilage can always move, scar, partial dissolve or contract creating a further dent or lump. 

 If you decide, at some point, to improve the appearance of the nose, a closed Rhinoplasty could be used to refine the nasal tip and even out the upper lateral cartilage area (where your dent is on the right side) to make things look more symmetrical.  Fillers like Juvederm would work well in this small dent but would need to be repeated about every 6 months or so.

All treatments you mention, including spreader grafts, onlay grafts, and fillers, will improve the appearance of the nasal dent. If there is any restriction of nasal breathing, the spreader graft would be th best choice. This can be done using the closed technique.  If a filler was used, I suggest Radiesse.

Hi,

Trying a filler such as silicone 1000, radiesse or Juvederm may be the easiest way to correct the dent. All fillers have pros and cons and your surgeon can discuss them with you. I would try a filler first. However, this can be fixed by putting a spreader graft through a closed approach. Either way find an experienced rhinoplasty surgeon.

Best,

Dr.S.