The External Strip and Internal Spreader Graft Combined with Dorsal Preservation Rhinoplasty

Overview

Preservation rhinoplasty keeps the bridge intact, but septal deviation is common and affects both appearance and breathing. Spreader grafts and flaps are standard in conventional rhinoplasty for correcting the open roof, deviation and bridge lines, but preservation does not create an open roof. The authors combined internal spreader and external strip grafts with preservation to address deviation and cartilage collapse without disturbing the bridge.

Sections of note

• Design: retrospective analysis of 152 dorsal preservation patients treated July 2019 to September 2022. Level of evidence therapeutic IV.
• External strip and internal spreader grafts were used in 52 of the 152.
• Inclusion: nasal hump deformity, C-shaped septal deviation or no deviation, and concavity of the upper lateral cartilage and the segment between the W-point and anterior septal angle.
• Median patient age 24.9 years. Follow up 16 to 26 months.
• Rhinoplasty Outcome Evaluation scores rose from a median 56.5 to 92.5, p less than 0.001.
• Patient satisfaction was excellent in 90 percent of cases, and the grafts addressed deviation, cartilage concavity and collapse without disrupting bridge integrity.

What it means for a patient

• Preservation handles the hump but not a deviated or collapsing septum, and these grafts add that correction without opening the bridge.
• Satisfaction scores rose substantially, with 90 percent rated excellent.
• The grafts were used in about a third of the preservation patients, so this addresses a subgroup rather than all cases.
• Limits: retrospective, single surgeon, no comparison against preservation without these grafts, and outcomes measured only by one satisfaction questionnaire.

Why this paper matters

Septal deviation is common among rhinoplasty patients and is one of the reasons preservation techniques are avoided in some noses. Adding grafts that correct it without disturbing the preserved bridge widens who can be treated. Whether the grafts affect hump recurrence, the main preservation failure mode, is not reported.

Terms

• Dorsal preservation rhinoplasty: lowering the bridge while keeping its natural surface intact.
• Spreader graft: a cartilage strip placed alongside the septum to hold the breathing valve open.
• Septal deviation: bending of the wall dividing the two sides of the nose.
• Open roof deformity: the flat gap left on top of the nose after a hump is removed.
• Upper lateral cartilage: the paired cartilages forming the middle third of the nose.
• Anterior septal angle: the forward corner of the septum near the tip.