Refining the SPLF Graft: Innovations in Revision Rhinoplasty

Reconstructing the dorsum in revision rhinoplasty remains a complex challenge. Traditional methods such as solid rib grafts and diced cartilage fascia (DCF) grafts present significant limitations, including warping, displacement, and insufficient dorsal definition. First devised in 2017, the SPLF (sandwich of perichondrium-lamina-fascia) graft has now become well-established in the senior author's practice as a refined, versatile, and customizable approach for dorsal reconstruction. This construct integrates seamlessly with native tissues, providing smooth contours, well-defined dorsal aesthetic lines (DAL) and consistent long-term results. Unlike conventional grafting techniques, the SPLF graft allows intraoperative adaptability, offering real-time customization of height, contour and lateral continuity through a multilayered design. In recent years, the SPLF graft as originally described has been progressively refined through variations in lamination thickness, shape and extensions, as well as the implementation of additional laminations and the innovative use of "rib plaster" for enhanced customization. These refinements have further legitimized its role as a cornerstone in revision rhinoplasty, providing surgeons with a predictable, stable and natural-looking solution for dorsal augmentation. Level of evidence: V.