The External Strip and Internal Spreader Graft Combined with Dorsal Preservation Rhinoplasty

Background: Rhinoplasty, particularly for the correction of dorsal hump deformities, has become increasingly common. Traditional methods, including hump resection, are frequently performed, while dorsal preservation techniques are gaining popularity. Septal deviation deformity is another common issue in rhinoplasty patients, significantly impacting both aesthetics and nasal function. Spreader grafts and flaps are essential components of traditional rhinoplasty to correct open roof deformities, deviations, or dorsal aesthetic lines. The aim was to combine internal spreader and external strip grafts with dorsal preservation rhinoplasty to enhance outcomes. Objective: This study aims to demonstrate the benefits of using external strip and internal spreader grafts in patients undergoing dorsal preservation rhinoplasty. Methods: A retrospective analysis was conducted on the records of 152 patients who underwent dorsal preservation rhinoplasty for nasal hump deformity, with or without septal deviation, between July 1, 2019, and September 1, 2022. External strip and internal spreader grafts were used in 52 of 152 patients. Inclusion criteria were defined as having a nasal hump deformity, cephalocaudal C-shaped septal deviation, no deviation, and a concavity at the ULC (upper lateral cartilage) and W-ASA segment (the area between the W-point and anterior septal angle) segment. Patients were evaluated using the Rhinoplasty Outcome Evaluation (ROE) questionnaire before and twelve months after surgery. Results: The median age of patients was 24.9 years. The postoperative follow-up period ranged between 16 and 26 months. The ROE scores significantly improved from a median of 56.5 preoperatively to 92.5 postoperatively (p<0.001). Patient satisfaction was excellent in 90% of cases. External strip and internal spreader grafts effectively addressed the deviation, ULC concavity, and W-ASA segment collapse without disrupting the dorsum's integrity. Conclusion: Combining external strip and internal spreader grafts with dorsal preservation rhinoplasty techniques provides effective solutions for correcting dorsal hump and septal deviation deformities, improving ULC concavity, preventing W-ASA segment collapse, and preventing and improving nasal valve collapse. This approach yields superior cosmetic and functional outcomes, offering an advanced method for rhinoplasty surgeons.