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

If not, what other methods would you recommend? I have read fillers are an alternative but they do not blend in and end up looking like a lump. Please share the possible methods of treating a small nasal dent (caused by nasal trauma) that makes my nose look crooked by listing their pros and cons. I really do not like to cause any further risk to my nose (internally and externally) while trying to treat this small dent. Thank you.

Doctor Answers 10

Small dent after nasal trauma

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 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.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Spreader graft through closed rhinoplasty

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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.  

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

Correcting dent

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

  1. spreader grafts
  2. camouflage onlay grafts
  3. fillers

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Nasal Dent after Trauma

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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.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Rhinoplasty for small indentation in a crooked nose

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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!

Michael Suzman, MD
New York Plastic Surgeon
4.9 out of 5 stars 29 reviews

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

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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.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

Spreader grafts with a closed rhinoplasty

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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,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Internal nasal valve collapse correction options

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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.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Small dent in nose

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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.

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

Small Nasal Dent

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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.



Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 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.