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

Question

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.

Sam Naficy, MD, FACS · Answer

Based on your photos it appears that you can be helped by:

	
		spreader grafts
	
		camouflage onlay grafts
	
		fillers

William Portuese, MD · Answer

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.

Michael Suzman, MD · Answer

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!

Mohsen Tavoussi, MD, DO · Answer

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.

Peter E. Johnson, MD · Answer

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

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

Answers (5)