Hello, 1 year ago I got my rhinoseptoplasty to fix a crooked nose with hump and deviated septum. Actually the result doesn't satisfact me, because my dorsum was narrowed too much and slightly scooped nomore than 2mm. My question is: 1- Can my dorsum be fixed with spreader graft to widen also my nasal bones almost to radix area like photoshop' pic? 2- Is it possible to widen them 2 mm approximately on each side if required? 3- Push outward left lateral cartilage, it is concave and I don't like
Widen Dorsum? (photo)
Doctor Answers 8
Overly narrowed nose can be widened.
It is certainly possible to widen overly narrowed nasal bones by reverse osteotomies and spreader grafts and any further adjustments to the nasal bridge profile can also be performed at the same time.
This is performed under general anesthesia as an outpatient procedure.
Revision rhinoplasty with spreader grafts can improve inverted V deformity on nasal dorsum
Spreader grafts may reduce the subtle defect that you see in the lateral dorsum on both sides. This technique can be tailored for functional and cosmetic reasons in my practice.
From the photos and description, you should do well with the following:
- dorsal cartilage graft
- spreader cartilage graft
- onlay grafting of the Left side of the nose.
- Assessment of the R side of the nose. It bone may be a little displaced.
- After septal surgery, the usual source of cartilage is the ear or rib.
- See a Board Certified Plastic or ENT Surgeon.
- Septorhinoplasties have a 10 - 20% chance of such reoperations.
- Hope this helps!
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Spreader grafts, dorsal augmentation, cartilage grafts, Facial Plastic Surgeon
What has caused some of the problem in your nasal dorsum is an overresection of the dorsum with loss of stability at the keystone region of the bony/cartilagenous junction causing narrowing also known as an inverted V-deformity. Spreader grafts will correct the narrowing but will not correct your percieved scooped out dorsum. This will require augmentation of the dorsum which is best accomplished with grafts of cartilage from your nose, ear or rib depending on the volume needed. revision can be performed successfully by a quailfied Facial Plastic Surgeon or Plastic Surgeon
Widening the middle vault with spreader grafts
The computer simulation you posted actually looks like a reasonable, achievable revision rhinoplasty result. Spreader grafts can be used to widen the middle vault, but only up to the transition between cartilage and nasal bones. The lateral walls of your nasal bones can certainly be made wider with a variety of possible onlay grafts. An alar batten graft would improve the concavity you dislike of your left lower lateral cartilage.
It is very possible to achieve your goals but an exam in person is necessary. If you have mid-vault collapse, spreader grafts can be helpful.
your photos are helpful.
i agree wit the comment about the inverted v deformity. in you case it is somwhat subtle but is present. you have asymetric and irregular dorsal aesthetic lines that coincide wit the sidewall irregularities. furthermore you still have some midvault deflection/deviation.
with that said, if you were one of my patients i would inform you that a revision in reasonable, spreader grafts would definitely be part of the plan, and you have a high likelyhood of needing costal (rib) cartilage grafts used in the case given that you stated that you had a septo-rhino in the past.
good luck and dont forget that austin, tx has a major airport. i see patietns from out of state frequently for nasal surgery. would love to help you with your desires for improvement.
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