The Evolution of the SPF-SPLF Graft in Rebuilding the Dorsum in Revision Rhinoplasty-an Update in an Over 300 Case Series

Robotti E, Clauss A, De Bernardis R, Leone F, Cottone G, Robotti S, Persichetti P.

PubMed 40826294 Publisher (DOI)Free full text (PMC)

What this paper says

In more than 300 revision cases from 2021 to 2024, a layered "sandwich" graft of perichondrium, thin rib slices and rectus fascia rebuilt the bridge with no infections, warping or significant long-term complications.

Overview

Rebuilding an over-resected bridge in revision surgery has relied on solid rib grafts (which can warp) or diced cartilage in fascia (which can look ill-defined or lumpy). Robotti's group describes the SPLF graft, used since 2017 and refined through more than 300 cases: layers of perichondrium, laminated rib cartilage and rectus fascia assembled and placed on the dorsum as one unit, sometimes with added "rib plaster."

Sections of note

More than 300 cases between 2021 and 2024.
Variations in dimension, shape and composition allowed intraoperative customisation.
Reported results: consistent dorsal height, smooth contour and well-defined dorsal aesthetic lines "indistinguishable from the native dorsum."
No infections, graft warping or significant long-term complications reported.
An algorithm for choosing graft configuration is proposed. Level of Evidence IV.

What it means for a patient

For a bridge that was taken down too far in a previous operation, this is an alternative to a solid rib block or diced cartilage.
In this large series the graft did not warp or become infected, two known problems with rib.
Results are reported by the operating surgeon without independent measurement or a comparison group.

Why this paper matters

It is one of the largest single-surgeon series of a specific dorsal reconstruction technique in revision rhinoplasty. Limits: retrospective, no objective outcome scores in the abstract, single surgeon.

Terms

Perichondrium: the membrane covering cartilage, used as a smooth outer layer.
Rib lamination: slicing rib cartilage into thin sheets that resist warping.
Rectus fascia: the sheath of the abdominal muscle, used as a wrap.
Diced cartilage in fascia (DCF): chopped cartilage wrapped in fascia, the main competing technique.
Dorsal aesthetic lines: the highlight lines from brow to tip that define the bridge from the front.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Reconstruction of the dorsum in revision rhinoplasty remains a challenge, requiring the balance of volume, proportion, and long-term stability. Traditional approaches-solid rib grafts or diced cartilage in fascia (DCF)-present limitations such as warping, poor definition, and surface irregularities.

Methods: Since its first application in 2017, the SPLF graft-a layered "sandwich" of perichondrium, rib lamination, and rectus fascia-has been progressively refined by the senior author. This construction is placed as a single unit onto the dorsum. In over 300 cases performed between 2021 and 2024, several variations in the SPLF's dimension, shape, and composition, including the addition of rib plaster, have allowed for high customization and optimization of dorsal contour and definition.

Results: The SPLF graft provided consistent dorsal height, smooth contour, and well-defined dorsal aesthetic lines (DALs), with outcomes indistinguishable from the native dorsum. No infections, graft warping, or significant long-term complications were observed in this series. The technique allowed intraoperative customization and demonstrated reliable long-term stability.

Conclusions: The SPLF graft has become the preferred method for dorsal reconstruction in revision rhinoplasty within the senior author's practice, offering a highly adaptable and stable solution that combines structural support and aesthetic finesse. An algorithm for its application is proposed based on this extensive experience.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).