V.D. Spreader Grafts

Spreader grafts are rectangular strips of cartilage placed between the septum and the upper lateral cartilages (Fig. 21).

Spreader grafts are helpful in circumstances when widening of the middle third is needed, a relatively uncommon but obvious circumstance. Also, spreader grafts can provide important additional support of the middle third of the nose in certain types of patients. This sort of patient has short nasal bones, long weak upper lateral cartilages, thin skin, and a narrow nose. Other patients who may need the additional support of spreader grafts include those who require a large hump reduction.

V.E. Tip Work

A tip that is too big or too full draws attention to itself and may detract from the patient's appearance. Many patients request refinement of the bulbous nasal tip so that it is proportional to the rest of their nose and their face.

Suture techniques represent a conservative and reliable way to make changes to the nasal tip. Suture techniques can be instrumental in refining a bulbous nasal tip (Fig. 22). Suture techniques can also
facilitate tip elevation (projection and rotation) (Fig. 23). Because there is no resection of tissue with this technique, it is felt that these techniques are relatively safe when performed by a skillful surgeon.

FIGURE 21. (a,b) Spreader grafts are rectangular strips of cartilage placed between the septum and the upper lateral cartilages.

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