Dr. Nassif: Since we’ve already performed the hump reduction and the osteotomies now it’s time for the spreader grafts. From the septocartilage that we harvested we have to carve some spreader grafts. Here are the grafts that will go in the middle part of the nose. The reason why we put spreader grafts in the upper part of the nose called the middle vault is because many times when you bring down a large hump and fracture the nasal bones, the middle part of the nose destabilizes and it can collapse in.
If it collapses in you will get something called an inverted V deformity which looks just like an upside down V. I might need some more cartilage. I’m going to use this part of the cartilage to hold up the front part of the nose, this will be called a columellar strut. It’s kind of not too strong. Ok what I want to do is I want to leave this here. I want to go back and take a little bit more cartilage from inside the nose. I’m going to take out a significant piece of cartilage here but most likely put back a lot of it. So we’re taking out another piece of septocartilage, here it is.
The two best sources of grafting material to use is septum number one, and two rib. Ear is the least desired graft to use.I’m looking at the thickness of the cartilage and we need a little bit thicker in this one right here. The reason why septum and rib are so much better than ear cartilage is because you can get a straight solid piece of cartilage. With the ear it’s always curved and it loses its strength sometimes after a year then it starts to collapse in and whatever you did you don’t like the result. It’s great to use for camouflaging something.
We’re just preparing the cartilage making it thin but not too thin. Alright let’s bring this over here. Now this is the challenging part putting these spreader grafts in the nose through a closed approach. We need some crazy glue; it’d be great for this. So you add the spreader grafts and place them in between the septum and the upper latero-cartilage and we stitch them in.
We’re just putting the last sutures along the spreader grafts just to make sure everything is in place perfectly. And that’s what we did with Luisa just to stabilize the middle part of the nose. In a sense it really doesn’t make the nose wider because when we take down the hump it’s already getting more and more narrow.
Today I saw Luisa, she’s about seven weeks following a closed rhinoplasty and septoplasty and turbinoplasty. We performed multiple procedures on her to take down her hump, make the middle part of the nose more symmetric, and fix her deviated septum to help open up her airway. The surgery went very smooth it’s exactly what I expected. At this point she’s very early in her healing phase, but she’s fine, everything looks great and she’s healing beautiful.