In this video, we're going to be demonstrating the technique of spreader flaps, often used after dorsal hump reduction. We take down the mucosa about two millimeters on the undersurface of the upper lateral cartilage. The upper lateral cartilage is left completely intact during the hump reduction. We've not sacrificed any of that tissue. This is going to facilitate the spreader graft placement. Note that the nasal mucosa is intact bilaterally. The spreader flaps are created by turning the medial edge of the upper lateral cartilage inward. A 27-gauge needle is being placed through the upper lateral cartilage and through the dorsal septum to hold the upper lateral cartilage out to length. We're going to want to maintain traction, caudally, on the upper lateral cartilage to pull it tight as we turn it under. A tapered 5-0 PDS suture is used to place horizontal mattress sutures to secure the spreader flaps and the dorsal septum. I don't personally score the upper lateral cartilage to allow the turnover to occur. I don't find that that's necessary. Note how both ends of the curved upper lateral cartilage are included in each bite of the spreader flap during this step. They can be done separately, but I tend to find that they work well if you do them together. The first suture is placed distally. The second is placed proximally. Remember, traction needs to be maintained caudally so that we will be able to hold the upper lateral cartilages out to length. I'll typically place two or three of these horizontal mattress sutures to secure the upper lateral cartilages, and then finally, an interrupted or simple suture can be placed at the most caudal aspect of the upper lateral cartilage to completely secure the closure. You'll see in another video how a flaring suture can be used caudally, so near the caudal edge of the upper lateral cartilage, to further secure an open internal valve when using a spreader flap technique. So I'd refer you to that video. At the completion, the mid-vault is completely repaired. A smooth dorsum is achieved, and you'll have nice dorsal aesthetic lines, which is probably one of the most important aspects of the spreader flap technique.

spreader flap technique

rhinoplasty

dorsal hump reduction

upper lateral cartilage

aesthetic dorsal lines