The use of short spreader grafts in rhinoplasty for patients with thick nasal skin

Overview

Spreader grafts hold the middle of the nose open after a hump is removed, but they also widen it. In patients with thick skin the lower bridge is already wide, so a full-length graft can make it wider still. The authors cut the graft short, ending it where thin skin gives way to thick, so the airway is supported without broadening the lower nose.

Sections of note

• 32 patients with thick nasal skin, closed rhinoplasty.
• Spreader grafts 1 to 2 cm long, extending only to the transition from thin to thick skin.
• Follow-up more than 1 year.
• Aesthetic improvement in all patients.
• Nasal airway patency improved or maintained in 94%.
• Level of evidence IV; the abstract does not state how aesthetics or breathing were measured.

What it means for a patient

• If your skin is thick, the surgeon may use shorter internal support grafts so that the lower part of the nose can be narrowed more.
• In this series breathing was protected in nearly all patients.
• Single surgeon, no comparison with full-length grafts, and outcomes were not measured with stated instruments.

Why this paper matters

It adapts a standard graft to skin type, part of a broader recognition that thick-skinned noses need different planning. Objective airway data and comparison with conventional spreader grafts are not provided.

Terms

• Spreader graft: a cartilage strip placed between the septum and upper lateral cartilage to hold the middle vault open.
• Thick nasal skin: a heavy skin and soft tissue envelope that hides definition and adds width.
• Internal nasal valve: the narrowest part of the airway, between the septum and upper lateral cartilage.
• Dorsal hump reduction: removing the bump of bone and cartilage on the bridge.
• Closed rhinoplasty: rhinoplasty through incisions hidden inside the nostrils.
• Nasal airway patency: how open the nasal passage is for breathing.