Daniel G. Becker, MD FACS
Becker Nose and Sinus Center, LLC
400 Medical Center Drive, Suite B
Sewell and Princeton, New Jersey USA
856 589-6673
856 589-3443 fax
drbecker@therhinoplastycenter.com

Clinical Professor & Director of Facial Plastic Surgery
Department of Otolaryngology-Head and Neck Surgery
University of Pennsylvania Medical Center
Philadephia, Pennsylvania

Clinical Professor
Department of Otolaryngology-Head and Neck Surgery
University of Virginia Medical Center
Charlottesville, Virginia

Evan Ransom, MD
Jason Bloom, MD
Charles Guy, DO

Abstract
Spreader grafts are an essential tool in the armamentarium of the rhinoplasty surgeon.  Spreader grafts provide  support of the middle vault and widen the internal nasal valve, the narrowest portion of the nasal airway which contributes approximately half of the total airway resistance.  Spreader grafts are frequently indicated in functional rhinoplasty and in revision rhinoplasty when middle vault collapse is encountered.  Also, spreader grafts may be employed during primary cosmetic rhinoplasty in selected situations.  Classically, the "high-risk"  patient has a narrow middle vault, short nasal bones paired with long upper lateral cartilages, or weak cartilaginous support.  Broader indications have also been advocated. Placement of spreader grafts can be performed in traditional external rhinoplasty (open) or via endonasal (closed) approaches.  In this article we will review patient selection, physical examination, procedure details, complications, and outcome assessment.  Lastly, two illustrative cases of the senior author will be presented.