Overly wide cartilaginous middle vault

Area of Science:

• Plastic Surgery
• Otolaryngology
• Facial Aesthetic Surgery

Background:

• Altering the upper lateral cartilages (ULCs) in rhinoplasty requires careful preoperative analysis of patient function and aesthetics.
• Established techniques for the middle vault often focus on dorsal hump reduction, internal nasal valve collapse, or twisted nose correction using spreader grafts.
• Some techniques, while addressing functional issues, can inadvertently broaden the nasal middle third.

Purpose of the Study:

• To introduce and describe the "reverse spreader technique" for aesthetic refinement of a broad nasal middle vault.
• To present an alternative approach that avoids functional compromise, unlike some traditional methods.
• To highlight a technique for patients with a wide middle vault but no internal nasal valve collapse.

Main Methods:

• The "reverse spreader technique" involves reducing the horizontal width of the cartilaginous dorsum.
• This is conceptually the inverse of using spreader grafts.
• The technique is applied selectively in cases of a broad middle vault without internal nasal valve collapse.

Main Results:

• The reverse spreader technique offers an aesthetic solution for a wide middle vault, creating the illusion of a narrower dorsum.
• It provides an alternative to dorsal augmentation in specific patient profiles.
• Caution is advised in patients with pre-existing internal nasal valve compromise.

Conclusions:

• The reverse spreader technique is a valuable addition to the rhinoplasty surgeon's armamentarium for managing broad middle vaults.
• It allows for aesthetic refinement without compromising nasal function when indicated.
• Careful patient selection is crucial to avoid exacerbating nasal valve issues.