Controlling nasal length with extended spreader grafts: a reliable technique in primary rhinoplasty

The short nose characterized by a reduced distance from the nasal radix to the tip represents a challenging deformity in facial plastic surgery. Several techniques have been described in the literature for augmentation of the short nose, but none emphasizes the surgical maneuvers necessary to preserve nasal length in primary rhinoplasty and to avoid the development of a short nose deformity.

The authors present a surgical technique for avoiding postoperative nasal shortness and for controlling nasal length in primary rhinoplasty. The procedure uses caudally extended bilateral spreader grafts, which prevent postoperative cephalic tip rotation and allow control of tip rotation. The grafts should be placed electively in noses that have the potential to become overshortened postoperatively. By doing so, surgeons can perform any of the common surgical maneuvers in rhinoplasty without risking short nose deformity. The study included 41 patients with a mean age of 27 years who were considered to be at high risk for the development of postoperative short nose deformity. All the patients were treated with bilateral extended spreader grafts via the open nasal approach. The follow-up period was up to 12 months, with regular evaluation of the surgical outcome comprising measurement of the nasal length and photographic analysis.

All the patients showed preserved nasal length after surgery with well-proportioned facial features. There was no evidence of postoperative nasal shortening after 12 months of follow-up evaluation. No operative or postoperative complications were detected. All the patients were pleased with the surgical results achieved.

The use of extended spreader grafts during primary rhinoplasty for selected patients represents a valuable tool for preventing short nose deformity after primary rhinoplasty.