What is the Success Rate of the Use of Spreader Grafts in Secondary Rhinoplasty?

Question

What is the success rate of the use of spreader grafts in secondary rhinoplasty? What’s their long term success rate? What’s their reabsorption rate? When it does go bad, what does it look like? Are there before and after pictures of failed operations? Thank you in advance

Evan Ransom, MD, FACS · Answer

Thank you for the great question. Spreader grafts help to support the sidewalls of the nose in primary and (especially) revision surgery. When these are created from your own cartilage, the resporption rate is basically zero. Spreader grafts can widen the middle third of the nose if they are made too thick, and this leads many surgeons to avoid using them. However, in cases when the bridge is being significantly reduced or the nose is crooked, they are essential to prevent long-term complications and airway obstruction. Graft displacement is quite rate, but can happen with blunt trauma to the nose or aggressive massage or picking after surgery. Whether or not spreader grafts are right for your surgery depends on the anatomy and function of your specific nasal components. Best of luck moving forward!

Kenneth Hughes, MD · Answer

Spreader grafts can be used to perform multiple functions. In general, resorption is not an issue. They tend to work well to provide functional as well as cosmetic benefit. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Kevin M. Robertson, MD, FACS · Answer

The success rate of spreader grafts first start with the correct diagnosis of internal valve collapse.  If that is indeed the case for you then you can expect improvement about 80% of the time.  That degree of improvement is probably even higher when incorporating a upper lateral cartilage flaring stitch as described by Park to the spreader graft reconstruction.  That's long term success rates, meaning there is little concern of graft resorption and loss of improvement or change in aesthetics.  Notice I said improvement, not resolution.  Because you would definitely have improved nasal airflow, but it's still possible that the surgery was successful and yet you still might feel some degree of airflow resistance.

	Spreader grafts obligate you to a very discrete widening of the nasal dorsum, an issue that has never been a concern to my patients.  In fact, most of the time it helps to balance the aesthetics of an overly narrow dorsal line of the nose, kind of like smoothing out an excessive hourglass shape. 

	Just like any part of surgery, the grafts can shift, warp, or be placed in suboptimal position.  That's why it's important to find a surgeon that specializes in rhinoplasty.

William Portuese, MD · Answer

Spreader grafts have an excellent success rate in primary or secondary rhinoplasty. Once a spreader graft has been placed, they integrate into the nose and are permanent. Rarely do we ever see one resorb. We have seen a couple of grafts where the graft has displaced upwards which creates a small bump on the bridge line or downward where becomes nonfunctional. A touch up rhinoplasty procedure is all that is required to adjust them.

Francis R. Palmer, III, MD (retired) · Answer

I have performed Rhinoplasty for over 25 years and do not use spreader grafts for one simple reason.  They increase the width of the nasal tip which is unattractive.

Randolph Capone, MD, FACS (in memoriam) · Answer

Since first introduced by Dr. Jack Sheen in 1984, the use of spreader grafts in rhinoplasty has proven to be a tried and true method for A.) improving airflow and B.) visibly correcting depressions or weakened portions of the central nose. Since they are grafted from your own cartilage (septum, ear, or rib), they are very unlikely to reabsorb and their effects are considered permanent. This goes for primary or revision rhinoplasty. If, however, your surgeon uses homograft rib cartilage (from a cadaver) there is felt to be a substantially greater chance of reabsorption of the graft and dissolution of any improvement felt after surgery. The second part of your question concerns what spreader grafts look like if they go bad. If these grafts are placed without care regarding their contour, there can be a palpable or sometimes visible ridge where the edge of the cartilage graft is. Also, if the graft is too wide, they can be unsightly like a lump on the side of the nose. Also, larger grafts more likely to extrude (migrate) or be rejected. In the hands of an experienced rhinoplasty surgeon, this is VERY unlikely. If you look at my patient's revision rhinoplasty Before/After photos on this site, you can see what spreader grafts can help achieve!

What is the Success Rate of the Use of Spreader Grafts in Secondary Rhinoplasty?

Answers (6)

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