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technique include those with a deviated dorsal septum,
asymmetric dorsal aesthetic lines, and upper lateral
cartilages of insufficient length at caudal end of the
septum. This population likely benefit from traditional
spreader grafts harvested from the nasal septum,
perhaps combined with autospreader flaps. The thickness
of free septal grafts can be varied to control asymmetry.
In the appropriate patient with nasal axial deviation
who also requires a septoplasty, the combined use of
autospreader flaps and unilateral or bilateral spreader
grafts may be indicated to correct asymmetric dorsal
aesthetic lines. Indications for the use of both techniques
include widening of the dorsal middle third of the nose
(especially in ethnic cases), bridging and strengthening
a long, narrow roof of the middle nose in patients with Figure 3: Combination use of the spreading grafting
short nasal bones and high LLCs, straightening and
stabilizing a dorsally deviated septum, and creating
ethnically acceptable dorsal aesthetic lines [Figure 3].
Nasal septal grafts are thicker and stronger, resisting
the deforming forces of a deviated septum and thus
correcting the curvature. Autospreader flaps alone
[18]
may not provide adequate stability when there is
associated collapse of the bony sidewalls. In these
instances, traditional spreader grafts that extend
beyond the keystone are indicated. For cases in which
an autospreader flaps cannot provide sufficient width at
the anterior septal angle, this area must be supported by
spreader grafts [Figure 4].

CONCLUSION
Figure 4: Indication for spreader graft procedure
The patient with a long nose, prominent dorsal hump,
short nasal bones and low LLCs are good candidates for
an autospreader technique [Figure 5]. The technique is
simple, reproducible and effective in shaping the dorsum
while preserving the function of the internal valve in
primary rhinoplasty patients. Subperichondrial dissection
of the nasal framework with preservation of the dynamic
musculoaponeurotic system and controlled manipulation
and repair of ligaments without disturbing the overlying
soft tissue allows reshaping and redraping of the nasal
aesthetic lines.
The relation between anatomical form and function is
of enduring interest in modern aesthetic plastic surgery,
being central to our understanding of physiological
systems. It provides lessons for engineering design based
on advanced anatomical knowledge. For now, limited
evidence available in PubMed that shows benefit of using Figure 5: Indication for the autospreader grafting
spreader flap technique for correction of dorsal septal
[24]
deviations. The use of a spreader flap technique has Conflicts of interest
not been described for special cases with minimal dorsal There are no conflicts of interest.
humps and secondary cases. The spreader architecture
rhinoplasty requires wider studies in compare and contrast REFERENCES
flap and graft techniques to identify which technology
provides the most benefit in terms of outcomes for more 1. Nahai F. Your favorite technique: time for a change? Aesthetic Surg J
durable, consistent, predictable and harmonic results. 2. 2012;32:900‑2.
Nahai F. Evidence‑based medicine in aesthetic surgery. Aesthetic Surg J
2011;31:135‑6.
Financial support and sponsorship 3. Gunter JP, Hackney FL. Clinical assessment and facial analysis.
Nil. In: Gunter JP, Rohrich RJ, Adams WP Jr, editors. Dallas Rhinoplasty:

318 Plast Aesthet Res || Vol 2 || Issue 6 || Nov 12, 2015