Are Spreader Grafts Compatible with a Supratip Break For Revision Rhinoplasty?

I am 14 months post-op and researching a revision rhinoplasty. I would like my shortened tip fixed. I spoke to a doctor who often uses spreader grafts to lengthen shortened tips. I've noticed that pretty much all of his revised noses using this technique don't have supratip breaks, including female noses. I am wondering then, if spreader grafts, aren't compatible with supratip breaks? Thanks in advance.

Doctor Answers 9

Spreader grafts and supratip break

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Spreader grafts are put on the sidewalls of the septum in the lower third of the nose to give strength to the upper lateral cartilages.  It also creates width across the mid third of the nose.  It can be done unilaterally or bilaterally depending upon the patient’s condition.  A supratip break is best addressed by setting the dorsal height correctly and having cortisone shots in the postoperative period for the first few months after the procedure.

Spreader graft compatibility with a supratip break for revision rhinoplasty

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An excellent question from someone who is quite knowledgeable about rhinoplasty. Revision rhinoplasty is considered the most difficult of all cosmetic procedures. It requires a great deal of education and experience to handle these types of cases. This in combination with an artful eye can result in predictable outcomes. When I consult with patients considering revision rhinoplasty, I spend a significant amount of time utilizing computer imaging. This allows the patient and surgeon to be on the same page discussing and planning the procedure. While it is important to review a competent surgeon's previous outcomes, the ultimate planning must be done on the individual. Some surgeons do have a "style." I prefer to let the patient guide me but still place some limitations so that the outcome will look natural. I prefer a supratip break on most of my rhinoplasties. It is very possible to create this look even with spreader grafts for revisional rhinoplasty. There may be a tendency to develop some scar tissue in the supratip. This is handled with post op kenalog injections and occasionally some light compressive massage.

Marc E. Yune, MD
Roswell Facial Plastic Surgeon

Spreader grafts and the supratip break

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Spreader grafts and septal extension grafts can be used to lengthen the nose or de-rotate the nasal tip. The supra tip break results from the relationship between the tip projection point and the bridge. The tip needs to project further forward than the bridge to allow for the "break" If spreader grafts make the bridge higher then the tip needs to be made just slightly higher than the bridge to create the break.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

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Are Spreader Grafts Compatible with a Supratip Break For Revision Rhinoplasty?

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 I have performed Rhinoplasty and Revision Rhinoplasty for over 25 years and your observations are correct.  IMHO, spreader grafts add volume (not the opposite) to the supratip area making the nasal tip appear wide and broad no matter how they are placed.    

 Spreader grafts are used along the nasal septum as it meets with the lower lateral cartilages (tip cartilages).  The intersection of these two anatomical units is called the "internal nasal valve".  I dislike the aesthetic appearance of spreader grafts and do not use them.  You will find a wide variation in opinions on what Rhinoplasty techniques will make your nose more attractive and you must determine which, of these, is aesthetically correct.  That, IMHO, should be the determining factor in selecting a plastic and cosmetic surgeon including a Rhinoplasty Surgeon.  Hope this helps.

Supratip break and spreaders

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There are many combinations of grafts that work together when you go to an experienced revision surgeon. Make sure he knows what you want before he operates and be very clear

Revision Rhinoplasty

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Spreader grafts are commonly used to extend the nose and they are compatible with supratip breaks.  Don't rely only on other patients' before and after photos.  Your results are the most important.  Please consult with a board certified specialist who can best assist you in achieving the results you desire.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Spreader Grafts Can be Compatible with Creating a Supratip Break in Rhinoplasty

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There are many ways to lengthen a "short nose" and extended spreader grafting techniques are just one of many. This technique in and of itself should not prevent the creation of a supratip break. A supratip break can be created by achieving adequate projection of the tip in relation to the dorsum or bridge of the nose. The tip complex is usually attached to the spreader graft / columellar graft complex to set tip rotation and projection. Because the short nose typically has too much rotation (upturn of the tip), great pains are taken to derotate the nose.

You should ask your surgeon regarding what his plans are for the overall shape of your nose. Some patients and providers prefer a straight line from the dorsum to the tip over the traditional supratip break. Let your concerns be known so that you and your surgeon will be on the same page.

Michael Kim, MD

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Lengthening the Nose

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Long spreader grafts can be used to lengthen the nose, and  they do not interfere with creating a supra-tip break if tip projection is established. The surgeon you describe may not  want supra-tip breaks. Find an experienced revision specialist and discuss your aesthetics.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

A number of grafts are used to lengthen a nose in revision rhinoplasty

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Extended spreader grafts are use as well as what are called caudal septal extension grafts to lengthen a nose. This is usually used in revision surgery or even in primary surgery for patients with upturned noses.

The addition of a supra-tip break is when the tip sits a little higher than the dorsum or upper part of the nose. This can be accomplished but often requires more grafting material. In order to get the result you desure it's important to discuss all your goals with your surgeon.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 134 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.