See how Seattle revision rhinoplasty surgeon, Dr. Thomas Lamperti, corrects a severely twisted and collapsed middle third of the nose using spreader grafting.
Earlier I reviewed what goes into repairing a pinched nasal tip with rhinoplasty. As promised, today I'll discuss some other aspects of the same patient's revision rhinoplasty surgery.
The photo above illustrates how twisted and collapsed the patient's middle third of her nose had become after her prior rhinoplasty over 20 years ago. She had a hump removed from her bridge at that time and her upper lateral cartilages weren't properly supported after surgery with spreader grafts. As the overlying skin contracted over the smaller nasal framework, the upper lateral cartilages collapsed and twisted.
How spreader grafts help to rebuild narrowed middle third of the nose
The before photo on the left schematically shows how spreader grafts were carved using the patient's septal cartilage. 
During her open revision rhinoplasty the spreader grafts were inserted between her septum in the midline and the distorted edges of her upper lateral cartilages. Long-acting dissolvable sutures were used to secure the spreader grafts in place until they permanently heal in their proper position.
You can see in the after photo on the right how a smoother, more seamless nasal contour was created using this technique. Additionally, by open up the patient's internal nasal valve, her breathing was also improved.
In my next post I'll discuss how I treated this patient's excessive columellar show, hanging columella and alar retraction.
