Rhinoplasty and Spreader Grafts

In many cases where patients are undergoing reshaping of the dorsum (bridge) I will recommend that we place spreader grafts at the time of the surgery. Spreader grafts are long, rectangular-shaped pieces of cartilage that are placed in parallel with the bridge in between the septum and the upper lateral cartilage. They are what we term ‘hidden’ grafts in that they are placed within a precise pocket without contacting the skin directly. This is in comparison to other grafts we use in rhinoplasty and revision rhinoplasty, such as tip and dorsal onlay grafts, that directly contact the skin and alter shape of the nose. Spreader grafts, in contrast, push or spread the upper lateral cartilage outward, thereby widening the middle one-third of the bridge indirectly. For this reason, the most common indication for spreader graft placement in cosmetic rhinoplasty is a pinched middle vault (another term for the middle one-third of the bridge). This can be a congenital finding in some patients who have never had rhinoplasty but also frequently occurs as a result of having had a prior nose job where this area of the nose was overlooked. In the latter instance, many of these revision rhinoplasty candidates present with what is called an inverted V deformity where the upper lateral cartilage has collapse inward creating unwanted shadowing in this particular shape. Other candidates for spreader graft placement are those with functional problems and difficulty breathing through the nose. These patients have narrowing of their breathing passage as a result of the upper lateral cartilage collapsing inward. When this occurs, a critical area inside termed the internal nasal valve becomes excessively narrowed causing a subjective feeling of difficulty breathing through the nose. In this case, spreader grafts are used to reopen the valve area and restore more optimal nasal breathing. It is for this reason that many patients who undergo spreader graft placement for cosmetic rhinoplasty also enjoy a moderate to significant improvement in their breathing as a passive side effect. To learn more about spreader grafts, you can read my online book chapter “Rhinoplasty, Spreader Grafts” on Emedicine.com (http://emedicine.medscape.com/article/1292527-overview).