Spreader Grafts in Rhinoplasty
The placement of spreader grafts is a common technique used in rhinoplasty and revision rhinoplasty. This technique has been used since the mid-1980s and is now employed to correct a variety of problems that are addressed through nose jobs. In New York, Dr. Rizk commonly uses this technique to correct functional problems that occur in the middle vault of the nose. This area is defined as the region between the nasal tip and below the nasal bones.
Spreader grafts can be a good choice when the middle portion of the patient’s nose is too narrow, which can make it difficult to breathe through the nose. They can also be used to keep the septum straight, and are sometimes used in revision rhinoplasty procedures.
Overview of Spreader Grafts for Rhinoplasty
By broad definition, a graft is a piece of material that is positioned in a location to correct a specific problem. In rhinoplasty, a spreader graft is typically created from the patient’s own cartilage and is used to strengthen the nose and allow for a long-lasting cosmetic and structural result.
The main purpose of a spreader graft is to open up the internal nasal valve region to improve breathing and/or increase the width of the middle vault. One of the most common uses of spreader grafts is to strengthen the nose after a hump reduction. After the hump has been removed, spreader grafts allow Dr. Rizk to reconstruct the nose and provide it with the strength necessary to retain proper nasal function and an ideal aesthetic result.
Spreader grafts can also be used to correct a twisted nose by placing the graft on one side to straighten the nose. These grafts may be used to address functional problems and restore proper airflow through the nose, or they may be required to address a cosmetic problem via nose surgery.
What are Spreading Grafts Made Of?
Spreader grafts are typically created using the patient’s own cartilage, as the cartilage can be easily incorporated into their nasal anatomy without fear of rejection. Common sources for this cartilage include the nasal septum, ears, and occasionally the ribs. Dr. Rizk will identify the best source of cartilage for your nasal graft after examining your nasal anatomy and determining the ideal approach for your rhinoplasty.
After obtaining the cartilage, Dr. Rizk then creates the spreader graft by carving out a rectangular portion of cartilage. The graft will be placed in the correct location during open or closed rhinoplasty. After placement, the graft is precisely sutured into its new location. A spreader graft can be used in combination with other revisions that have been specified for your nose surgery.
Risks Associated with Spreader Grafts
A risk associated with spreader grafts is the appearance of an irregular contour on the surface of the nose. Many rhinoplasty specialists believe spreader grafts should only be used in the most extreme cases, in part because they can make the nose a little bit (but noticeably) wider. Spreader grafts add width to the middle vault of the nose and open up the valve area. They are typically placed between the septum and upper lateral cartilage. Depending on the procedure, they may be placed through an open approach or an endonasal approach.
By working with an experienced doctor, these risks are significantly minimized. Dr. Rizk understands the complexities of working with spreader grafts and the ways in which each patient’s unique anatomy and skin thickness can affect the outcome.
Additional Types of Grafts Dr. Rizk Uses in Rhinoplasty
There are a number of types of grafts used in rhinoplasty. Here are some of the grafts Dr. Rizk uses most often:
Alar Batten Grafts
Alar Batten Grafts are often used to prevent or correct a nasal valve collapse, namely when the collapse is caused by weakness in the nasal sidewall. (A collapsed nasal sidewall causes narrowing of the nasal valve, which can potentially lead to breathing problems.) They can also be used to prevent alar retraction or to correct a “pinched” appearance.
Alar batten grafts are often used in combination with a septoplasty or septorhinoplasty procedure. They are placed just above the lower lateral cartilages. They may be harvested from the septum or ear, but Dr. Rizk prefers to use septal cartilage grafts because they are stronger.
Onlay Grafts and Umbrella Grafts
These grafts are often used in rhinoplasty techniques focusing on tip support. Onlay grafts project the nose’s “dome” while umbrella grafts are used in under-projected nasal tips.
How Dr. Rizk Uses Grafts in Rhinoplasty
Dr. Rizk uses grafts for a number of different rhinoplasty techniques. They are useful in narrowing or improving the projection of the nasal tip, lessening excess curvature, providing definition and support, widening the nostrils and for many other purposes.
Here are some of the procedures grafts can be used for during rhinoplasty:
- Tip refinement: Just about any alteration to the nasal tip compromises its support structure. If tip support is weakened, it is often necessary to perform tip refinement to provide added support with cartilage grafts.
- Alar base reduction: An alar base reduction is a technique used during primary or revision rhinoplasty to correct nostrils that are too wide. It often involves the use of a cartilage graft.
- Correcting a bump: If a bump looks large as a result of a pronounced depression between the eyes, a graft can be used to fill the depression, thereby eliminating the bump.
- Revision rhinoplasty: Grafts are often needed during revision rhinoplasty to strengthen and rebuild the nose. Spreader grafts, nasal batten grafts, and composite grafts are some of the types of grafts used during revision rhinoplasty.
- Surgery for a broken nose: A broken nose may require cartilage grafting. For example, spreader grafts may be used to strengthen the existing cartilage and/or to align the midline of the nose and teeth.
- Functional rhinoplasty: A functional rhinoplasty is a nose surgery performed in order to improve breathing. This may involve spreader grafts for internal valve narrowing or other techniques to correct an external valve collapse.
- Internal/external valve collapse and stenosis: Internal valve collapse can be treated by putting strips of cartilage in the collapsed section, or by reattaching cartilage to the septum.
To learn more about Dr. Rizk’s use of grafts in rhinoplasty, contact our office today.
Which Graft Materials Does Dr. Rizk Prefer?
Whenever possible, Dr. Rizk prefers to use cartilage harvested from the patient’s own septum or ears. It is a good idea to use the patient’s own cartilage because there is a much better chance that it will be well-tolerated by the body. If necessary, Dr. Rizk will use a synthetic graft called Medpor for support or definition.
Furthermore, Dr. Rizk also uses irradiated cartilage (harvested from a cadaver) in some cases, especially in revision rhinoplasty procedures in which the nasal framework needs to be reconstructed. Irradiated cartilage becomes necessary when ear cartilage will not suffice (because stronger cartilage is needed) and the patient has no extra septal cartilage to harvest. It is particularly useful for supporting the nasal tip when a stiff, flat piece of cartilage is needed.
It should also be noted that there are types of grafts Dr. Rizk does not like to use. For example, he never uses silicone grafts. He also avoids using grafts from a patient’s own rib due to potential scarring, the risk of damage to the lung and/or pleura (the tissue that surrounds the lung), and the potential for this type of graft to dissolve over time.
Find a Reliable Rhinoplasty Specialist in NYC
If you are seeking a doctor to perform your nose job in NYC, contact our office to set up an initial consultation. After examining your nasal anatomy and gaining an understanding of your goals, Dr. Rizk will recommend a surgical approach, which may include the placement of a spreader graft. When working with our facial plastic surgeon expert in Manhattan, you can be sure that his years of experience will allow him to choose the best approach to provide you with the results you desire.
If you would like to learn more about working with Dr. Rizk, get in touch with his practice and book a consultation today.
Written by Dr. Sam Rizk
Date Last Modified: 02/03/2020