Free spreader grafts in rhinoplasty

BACKGROUND: Spreader grafts (SPG) are widely used for different purposes in rhinoplasty procedures. However, selection of the size of the grafts, trimming and fixation often proved time consuming and difficult. We used an original method of placement of “free” SPG to improve both ease of placement and fine trimming of the grafts. To assess pertinence of this approach, we evaluated retrospectively our rate of correction of the middle third of the nose. METHODS: We used a personal method for securing SPG after suturing upper lateral cartilages (ULC). Grafts were inserted between the ULC and nasal septum, adding fibrin glue for fixation. We reviewed the aesthetic results of a series of 420 consecutive rhinoplasties in whom free SPG were used in 218 patients and conventional fixed SPG were used in 33 patients. Retrospective analysis of the photographic data of all patients was performed. Adequacy of brow tip lines, symmetry and relative width of the middle third was assessed by an independent observer and the surgeon. RESULTS: No evidence of postoperative displacement was noted. Symmetry of the middle third of the nose and adequacy of aesthetic brow tip lines were obtained in the vast majority of the patients. Comparable rates of middle vault correction and harmony were obtained in patients with free SPG or conventional SPG. On occasion during revision surgeries, we found the grafts resting in adequate position. CONCLUSIONS: Free SPG placement appeared a straightforward and timesaving method in rhinoplasty procedures and proved especially meaningful when limited to moderate amount of support was needed in the middle vault reconstruction. Repositioning, resizing of the graft or placement of additional pieces of cartilage were feasible instantly if needed. This technique might help to obtain better correction of the middle third due to easiness and possibility of fine adjustments in rhinoplasty procedures. Level of Evidence: Level III, therapeutic study.