Now all rhinoplasty surgeons are familiar with the internal nasal valve, which is considered the narrowest portion of the nasal airway. The nasal valve is defined by an angle of 10-15 degrees formed by the lower border of the upper lateral cartilage where it joins with the septum. Underneath this angle is the more important nasal valve area, which is the cross sectional surface area beneath the nasal valve angle. The nasal valve area can be blocked by enlargement of the inferior turbinate, deviation of the septum, and other structural problems.

At times spreader grafts (also known as “spacer grafts”) may be placed to widen the middle portion of the nose and increase the internal nasal valve angle and the internal nasal valve area. Also, these can be placed asymmetrically to improve any cosmetic deviation of the nose in this region.

Also, when a large nose is reduced, it is important to realize that the cross sectional area in this region will be narrowed, and so counter-measures must be undertaken to preserve the cross sectional area at this critical location. So when a patient – such as this one – has a very large nose to begin with, we place spreader grafts during reduction rhinoplasty to maintain a good nasal airway. Otherwise the patient may have a nice looking nose but he may have a nose that doesn’t work!

So these are some of the subtle technical details that are important to having the best chance of functional and cosmetic success.

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