Possible To Narrow Nose After Spreader Graft Made It Too Wide?

A revision can be done if your nose is too wide after having a spreader graft placed. The graft can be narrowed and replaced. I would  caution you not to proceed too soon after your most recent surgery. The nose can evolve and the overlying skin contract quite a bit over time so you want to make sure all the healing is complete.

It is very difficult to make the nose narrower in light of the fact that the spreader graft is in place.  There are some subtle maneuvers that can be performed such as trimming back the cephalic margin of the lower lateral cartilage in the scroll area to slightly narrow and reduce the nasal tip.  The only other option would be to narrow the spreader grafts which will be counterproductive to what was accomplished in the last revision.  Osteotomies will narrow the nasal bones if they have not been done already.

Hello, Kentucky.

Do not be discouraged. Generally the nose can be narrowed, even after two prior rhinoplasties.

You need to consult an expert in revision rhinoplasty. That doctor will focus on noses in his practice and have plenty of before and after photos to share with you so you can see how he handled similar cases.

Also, be sure to have computer imaging so everyone is in agreement on what the expected outcome will be.

When you consult, be sure to bring copies of all the records of the first two rhinoplasties, including before and after photos. Op reports and chart notes, also, of course.

Good luck.

 

Robert Kotler, MD, FACE

Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

Author, THE ESSENTIAL COSMETIC SURGERY COMPANION.

The important question is why were spreader grafts placed? I f your septum is straight and your turbinates are not enlarged and there was a valve collapse and the spreaders were placed to improve your airway, you may be compromising your breathing if they are removed. On the other hand, if they were placed because the middle third of your nose was too narrow, they can be trimmed to make the nose more narrow. If the nose is wide because the nasal bones (upper third) are broad, then you might need osteotomies. 

Spreader grafts taken from the nasal septum is about 1mm wide. So you have one on either side this will give a width of 2mm. Do you think it is worth the surgery to remove the spreader graft to decrease the width by 2mm????? If so then YES the spreader graft can be taken out. The sooner after surgery the easier.

You should wait an acceptable period of time before revision, and realize the reason for the spreader grafts in the irst place; either to improve valve function, straighten the dorsum, or both. A possible solution is a simple onlay graft which is narrow enough to provide the illusion of a narrower dorsum without disturbing the spreader graft construct structurally. I would discuss this with the surgeon and ask for computer imaging as well.

 

 Yes, during Revision Rhinoplasty it would require removal of the spreader grafts and may require bone rasping or other measures as I don't have photos for evaluation.  This is the issue that I have had with spreader grafts over the past 20 years...they make the nose and nasal tip look wide when they are used frequently making the nose unattractive.

The increased width of your bridge after your revision rhinoplasty can be reduced but a physical examination and review of your operative report will be necessary to determine the cause of this undesirable appearance. If the spreader grafts are responsible, your breathing function must be carefully evaluated before reducing or possibly eliminating the grafts.