I had a rhinoplasty a few years back and now am having trouble breathing. I have an inverted V slight pinch in the tip of my nose. The nose collapses upon forced inspiration. I get relief with a breathe right strip and like the way it looks and feels with the strip on. I have gotten 2 opinions on how to fix it 1 spreader grafts from septal cartilage and possible batten grafts or 2 a graft with ear cartilage that acts as a breathright strip and wafer grafts to fill the dents. Which is better?
Will Spreader Grafts Strengthen a Weak Lateral Sidewall in Revision Rhinoplasty?
Doctor Answers 7
Revision Rhinoplasty For Weak Nasal Sidewalls
Thank you for asking an important question.
Without photos and physical examination, it is not possible to give you a solid opinion.
Nonetheless, you bring up spreader grafts and wafer grafts and here is my opinion about both:
- Spreader grafts will serve as a structural support preventing the collapse you have described.
- The Wafer grafts serve more of an aesthetic function filling the dents you described.
I encourage you to seek consultation with a surgeon of extensive experience in that field who will be able to examine you and guide you to make a well informed decision.
Best of luck to you and thank you for your inquiry.
Treating weak lateral sidewall with surgery
We could give you a better idea of what type of grafts would help after seeing your nose, but it does sound like structural grafting would be beneficial. Spreader grafts will help treat the inverted V problem. The question of where to get the cartilage from depends on how much septal cartilage you have remaining. You may need a combination of septal and/or ear cartilage depending on what can be harvested from your septum. You can check out my link below that discusses surgical breathe right strip surgery in more detail.
Rhinoplasty struts and grafts
It is impossible to make specific recommendations in the absence of photos or a face to face examination. Your question is an important one though because there is a vast difference between spreader grafts that are placed between the septal and upper lateral cartilages vs. crushed cartilage grafts or wafer grafts placed on top of the native nasal cartilages. The first gives you a structural support that should correct the middle vault collapse you describe. The second is a means of camouflaging indents that does not provided the needed structural support.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
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Inverted V-deformity, upper lateral cartilage collapse and internal nasal valve obstruction.
The inverted-V deformity is a classic long term complication following overly aggressive reduction rhinoplasty. It is commonly associated with narrowing of the internal nasal valve and nasal obstruction. The cause is related to loss of support of the upper lateral cartilage resulting in their inward and downward collapse. Spreader grafts are designed to reposition and support the upper lateral cartilages and open the nasal valves. Although other grafting techniques have been described, the majority of surgeons and reports in the medical literature favor spreader grafts. Onlay batten grafts are used primarily to restore loss of support resulting from weakened lower lateral cartilages, particularly where they meet the upper lateral cartilages in the so-called "scroll region".
Mario J. Imola, MD, DDS, FRCSC.
Breathing problems after rhinoplasty
It sounds like you have nasal valve problem (possibly both internal and external) which, unfortunately, is one of the potential complications of rhinoplasty surgery. I have to complement you on your knowledge of the ways to correct this problem. If you trully have an inverted V deformity, then your internal nasal valve is collapsed and the best way to correct this would be with the spreader grafts/ upper lateral cartilage grafts/flaring suture of the upper lateral cartilages. The precise method should be determined based on your examination. Pinch at the nasal tip may signify some problem at the external nasal valve area - this is commonly corrected with alar batten or alar strut grafts. Again, hard to advise accurately since there are no pictures. Please keep in mind, that you may not have enough septal cartilage left at this point, so your grafts may need to come either from ear cartilage or rib cartilage - this would depend on how much and what kind of cartilage is needed. You need to get a consultation with a rhinoplasty surgeon who has a great experience with revision rhinoplasty surgery.
Spreader grafts help with breathing when there is mid vault collapse. These are best harvested fro the septum.
Spreader Grafts to Improve Breathing
Spreader grafts are are good choice to improve nasal breathing and correct the inverted V deformity. The grafts can be taken from the septum as long as there is enough cartilage after your previous surgery or ear cartilage can be used.