Upper Lateral Cartilage Spreader Flaps in Rhinoplasty
Abstract
During primary reduction rhinoplasty, when cartilaginous vault lowering is done, the excess height of the upper lateral cartilages is usually discarded. If lateral osteotomies are then necessary to close an open dorsum, overnarrowing of the osteocartilaginous vault may result. To prevent unwanted narrowing, prophylactic spreader grafts can help establish the normal horizonal 4 to 6 mm width of the mid dorsal skeletal lines. An alternative to spreader grafts (particularly when there is no indication to enter the septum) is to preserve the excess height of the upper lateral cartilages and convert it to horizontal flaps to restore the normal T shape of the upper portion of the mid cartilaginous vault at the lower dorsal height.1 The obvious indications for this technique are either primary or secondary cases requiring enough dorsal cartilaginous septal reduction to allow conversion of the excess upper lateral cartilage vertical height to horizontal width. Our technique includes the following steps (Figure 1).
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Dorsal Preservation: The Push Down Technique Reassessed
Saban, Y., Daniel, R. K., Polselli, R., et al. (2018) · Aesthetic Surgery Journal · doi:10.1093/asj/sjx180 · Cited by 309 · see citing works
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“If the result does not look satisfying, then, sequentially, the second step can address the bony cap by using piezo instruments and reshaping the bones; the cartilaginous vault can thenbe eitherpreservedor adapted by remodeling the septum–ULC junction [26, 29, 30] or divided leading to ULC surgery and spreader flaps […”
Manavbaşı, Y. İ., & Başaran, İ. (2011) · Aesthetic Plastic Surgery · doi:10.1007/s00266-010-9641-4 · Cited by 32 · see citing works
“Besides the graft techniques, one of the most common alternatives is the spreader flap [5].”
MethodUse of Spreader Flaps Without Dorsal Hump Reduction and the Effect on Nasal Function
Sowder, J. C., Thomas, A. J., Gonzalez, C. D., Limaye, N. S., & Ward, P. D. (2017) · JAMA Facial Plastic Surgery · doi:10.1001/jamafacial.2016.2057 · Cited by 22 · see citing works
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“Although spreader grafts are widely used to reconstruct the middle third of the nose, the need to harvest sufficient cartilage leads to preserving the upper lateral cartilages (ULC), folding the medial-most aspect on itself, and using it as a ‘‘spreader flap’’ [5–9], which was later called an ‘‘autospreader’’ or ‘‘tur…”
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Avashia, Y. J., Marshall, A. P., Allori, A. C., Rohrich, R. J., & Marcus, J. R. (2020) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000006850 · Cited by 21 · see citing works
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Motamedi, K. K., Stephan, S. J., & Ries, W. R. (2015) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0000000000000217 · Cited by 21 · see citing works
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“[18] in 2014 published an interesting article in which they affirmed that the spreader flap is an attractive approach for preserving the middle vault in nasal plastic surgery; however, its effect needs further evaluation.”
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Küçüker, İ., Özmen, S., Kaya, B., et al. (2013) · Aesthetic Plastic Surgery · doi:10.1007/s00266-013-0258-2 · Cited by 17 · see citing works
“Cartilage flaps in rhinoplasty gained popularity in the past few years as they offer advantages similar to those of cartilage grafts but with less donor site morbidity [5, 9–12].”
BackgroundIntermediate and Definitive Cleft Rhinoplasty
Gary, C. C., & Sykes, J. M. (2016) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2016.06.017 · Cited by 17 · see citing works
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“The more modern iteration, used in midvault reconstruction after dorsal hump reduction, was described by O’Neal and Berkowitz [6].”
MethodThe accordion suture technique: A modified rhinoplasty spreader flap
Görgülü, T., Özer, C. M., & Kargı, E. (2015) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2015.03.036 · Cited by 13 · see citing works
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Kovacevic, M., Buttler, E., Haack, S., et al. (2020) · HNO · doi:10.1007/s00106-020-00949-3 · Cited by 11 · see citing works
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Sazgar, A. A., Razmara, N., Razfar, A., Sazgar, A. K., & Amali, A. (2019) · Journal of Plastic, Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2019.06.022 · Cited by 8 · see citing works
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Gruber, R. P., Holland, M. C., Rochlin, D. H., Sue, G. R., & Moshrefi, S. (2022) · Aesthetic Plastic Surgery · doi:10.1007/s00266-022-02856-0 · Cited by 6 · see citing works
“These modalities have included the original spreader grafts, spreader flaps [35] and extended spreader grafts.”
BackgroundUpdate on the evidence for functional rhinoplasty techniques
Chan, D., & Shipchandler, T. Z. (2015) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0000000000000172 · Cited by 7 · see citing works
“Spreader flaps The spreader flap technique was first reported in the late 1990s to widen the mid-vault [43].”
Background„Flaring spreader flaps“ und „upper lateral advancement“
Wurm, J., & Kovacevic, M. (2012) · HNO · doi:10.1007/s00106-011-2427-4 · Cited by 8 · see citing works
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“The tension of the ULCs was reported to be a key point for better results in terms of both aesthetics and functionality after humpectomy operations.(9,10) In these reports, the importance of suturing techniques were reported as well as the significant duties of spreader grafts.”
BackgroundExtended Spreader Graft Placement Before Lateral Nasal Osteotomy
Küçüker, İ., & Özmen, S. (2013) · Aesthetic Plastic Surgery · doi:10.1007/s00266-013-0168-3 · Cited by 7 · see citing works
Hahn, S., & Becker, D. G. (2013) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0000000000000011 · Cited by 7 · see citing works
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Naguib, M. B., Rifaat, M. A., Madian, Y. T., Elnahriry, T. M., & Eldeeb, W. E. (2020) · Acta Scientific Otolaryngology · doi:10.31080/asol.2020.02.0075 · Cited by 7 · see citing works
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The Twisted Nose: What to Do When It's Not Straight
Gonzalez, J., & Winkler, A. A. (2018) · Facial Plastic Surgery · doi:10.1055/s-0038-1653987 · Cited by 6 · see citing works
Intraoperative Suction-Assisted Evaluation of the Nasal Valve in Rhinoplasty
Zoumalan, R. A., Larrabee, W. F., & Murakami, C. S. (2012) · Archives of Facial Plastic Surgery · doi:10.1001/archfaci.2011.1111 · Cited by 6 · see citing works
“Because some terms used in the table may be unfamiliar to the reader, we will elaborate: Auto-spreader flap: Redundant dorsal portion of the upper lateral cartilage can be used as its own “auto-spreader” flap by turning in the dorsal portion into the area normally used for the spreader graft.(14,15) This provides the…”
Assessment of Functional Outcomes of an Autospreader Flap and Spreader Graft in Rhinoplasty
Aydoğdu, İ., Bayram, A. A., & Aydoğdu, Z. (2022) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000008044 · Cited by 5 · see citing works
“Recently, researchers have described new techniques that use the dorsal segment of the upper lateral cartilage as an autospreader graft.(7) In another method, an autospreader flap is used, in which the dorsal part of the upper lateral cartilage is folded and used as a graft.”
MethodTechniken der Nasenrückenkorrektur
Heppt, W. J. (2013) · HNO · doi:10.1007/s00106-013-2669-4 · Cited by 5 · see citing works
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“Its given name evolved from “upper lateral cartilage bending” by Seyhan in 1997[6] to the “Lapel technique” a year later by Lerma[7] however in the same year Oneal and Berkowitz gave it its current name; spreader flaps[8].”
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Avashia, Y. J., Martin, H. L., Frank-Ito, D. O., et al. (2022) · FACE · doi:10.1177/27325016221138749 · Cited by 5 · see citing works
Commentary on: A Complete Subperichondrial Dissection With Management of the Nasal Ligaments
Gruber, R. P., Belek, K. A., & Barzin, A. (2012) · Aesthetic Surgery Journal · doi:10.1177/1090820x12449621 · Cited by 5 · see citing works
Nasal Obstruction after Mohs Surgery: Prevention and Correction
Rudy, S. F., & Moyer, J. S. (2020) · Facial Plastic Surgery · doi:10.1055/s-0040-1701481 · Cited by 4 · see citing works
Inverted-V Deformity: An Anatomic Study
Minelli, L., & Callan, P. (2022) · Aesthetic Surgery Journal · doi:10.1093/asj/sjac217 · Cited by 4 · see citing works
AlAwadh, I., Bogari, A., Assiri, H., et al. (2022) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000008847 · Cited by 4 · see citing works
Alar cartilage—an alternative for spreader graft in primary rhinoplasty
Uebel, C. O., & Ramos, R. M. (2017) · European Journal of Plastic Surgery · doi:10.1007/s00238-017-1336-5 · Cited by 4 · see citing works
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BackgroundFour-Step Spreader Flap: The Pull-Twist-Turn Technique
Rohrich, R. J., & Durand, P. (2021) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000007661 · Cited by 4 · see citing works
“8,9 The four-step spreader flap technique described by the authors offers a simple, reproducible method of shaping the dorsal midvault while preserving internal valve function, especially in a primary rhinoplasty with the following: (1) greater than 3 mm of dorsal hump reduction; (2) strong upper lateral cartilages; a…”
MethodSurgical Treatment of Dynamic Nasal Collapse
Ji, K. S. Y., & Krane, N. A. (2022) · Facial Plastic Surgery · doi:10.1055/a-1825-2610 · Cited by 4 · see citing works
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Yankov, D. V. (2014) · Scripta Scientifica Medica · doi:10.14748/ssm.v46i1.649 · Cited by 4 · see citing works
“The potential of ULC’s flaps as a substitute of spreader grafts has been described (3,5,12).”
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Hafezi, F., Naghipour, R., Naghibzadeh, B., et al. (2020) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000006815 · Cited by 4 · see citing works
Kim, M. H., Martin, H. L., Avashia, Y. J., Sicard, R. M., Chiang, H., Woodard, C. R., Marcus, J. R., & Frank-Ito, D. O. (2025) · FACE · doi:10.1177/27325016241310616 · Cited by 3 · see citing works
Epidemiological profile of patients undergoing rhinoplasty in a hospital rehabilitation center
de Arruda, F. C. F., GONÇALVES, P., Florencio, P. R., et al. (2021) · Revista Brasileira de Cirurgia Plástica · doi:10.5935/2177-1235.2021rbcp0007 · Cited by 3 · see citing works
“The spreader also assists in the rectification of septum 19 , 20 .”
An Alternative Method for Midvault Restoration: “T-Splay Graft”
Kopal, C., & Kapı, E. (2021) · Aesthetic Plastic Surgery · doi:10.1007/s00266-021-02632-6 · Cited by 3 · see citing works
Çağıcı, C. A. (2017) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2017.10.011 · Cited by 3 · see citing works
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“Spreader grafts were first described by Sheen for disrupted medial roof reconstruction while Oneal and Berkowitz defined spreader flaps as an alternative to medial roof reconstruction.(2,3) On the other hand, some authors do not recommend the routine use of spreader techniques in all septorhinoplasty surgeries.”
BackgroundClassification of Spreader Flap Techniques
Seyhan, A. (2017) · Facial Plastic Surgery · doi:10.1055/s-0037-1604175 · Cited by 2 · see citing works
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Evidencia medida de resultados en rinoplastia abierta convencional con autoinjertos espaciadores
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Dorsal Hump Reduction and Midvault Reconstruction
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Apaydin Classification of Spreader Flaps Updated
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“2,3 Notably, one major advantage of SFs is that they obviate the need for additional grafts from external sources.”
Is There a Risk of Saddle Nose Deformity after Spreader Grafts and Flaps?
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Discussion of the Article by Fayman and Potgieter
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“I have had a very satisfactory personal experience with it over the past 10 years along with Oneal and Berkowitz [8].”
BackgroundInfluentialCommentary on: The Composite Spreader Flap
Gerbault, O. (2018) · Aesthetic Surgery Journal · doi:10.1093/asj/sjy170 · Cited by 1 · see citing works
Autoespaciador en rinoplastía por técnica abierta y cerrada
Fernando Casanueva, L., David Astudillo, O., Alfredo Santamaría, C., et al. (2015) · Revista de otorrinolaringología y cirugía de cabeza y cuello · doi:10.4067/s0718-48162015000200004
Our experience with spreader graft in septorhinoplasty by open approach
Tiwari, M., Kumar, S., Goel, H. C., & Sa, C. J. A. D. (2018) · International Journal of Otorhinolaryngology and Head and Neck Surgery · doi:10.18203/issn.2454-5929.ijohns20181865
Evidence-Based Practice: Functional Rhinoplasty
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Moderne nachhaltige Techniken der funktionell-ästhetischen Septorhinoplastik
Riedel, F., Kovacevic, M., Bran, G. M., Alamuti, N., & Wurm, J. (2018) · Journal für Ästhetische Chirurgie · doi:10.1007/s12631-018-0130-y
“„Spreader flaps“ Das Prinzip der „spreader flaps“ geht auf die Beschreibungen von Seyhan [39] sowie Oneal und Bergowitz [29] aus den1990er-Jahrenzurück.”
Rhinoplasty and Orthognathic Surgery
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Securing cartilage grafts in closed rhinoplasty
Filson, S. A. (2019) · Journal of Dermatology & Cosmetology · doi:10.15406/jdc.2019.03.00114
What We Have Lost by Forgetting Endonasal Rhinoplasty
Constantian, M. B. (2021) · Facial Plastic Surgery · doi:10.1055/s-0041-1730386
Modified perichondrial-periosteal flaps to camouflage nasal dorsum in rhinoplasty
Khafagy, A. G., Elsersy, H. A., & Maarouf, A. M. (2021) · The Egyptian Journal of Otolaryngology · doi:10.1186/s43163-021-00127-4
Garefis, K., Konstantinidis, I., Tsetsos, N., et al. (2022) · Rhinology Journal · doi:10.4193/rhin21.235
“Wood again described the technique in 1992, while Berkowitz and Oneal presented the term SF in 1998 (8,9) .”
MethodEastern Mediterranean Nose Correction
Apaydın, F. (2022) · Springer eBooks · doi:10.1007/978-3-031-05551-5_12
Component Hump Resection With Placement of Spreader Grafts
Kerolus, J. L., & Azizzadeh, B. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-69775-0.00022-6
Racy, E., Edery, N., Fanous, A., et al. (2022) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000009731
23 Middle Eastern Primary Rhinoplasty (Expert Commentary)
(2023) · Thieme Medical Publishers eBooks · doi:10.1055/b-0043-193224
Functional Considerations for Preservation Rhinoplasty, Nasal Valve, and Clinical Cases
Racy, E., Fanous, A., D’Andréa, G., & Benmoussa, N. (2023) · Springer eBooks · doi:10.1007/978-3-031-29977-3_9
Spare Roof Technique: Preservation Rhinoplasty in the Era of Osteo and Chondroplasty
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52 Surgery of the Nasal ValveNasal valve
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Reduction Rhinoplasty's Bad Wrap—Is it Time to Forgive and Forget?... Or at Least Get a Rebrand?
Deane, E. C., & Friedman, O. (2025) · Facial Plastic Surgery · doi:10.1055/a-2611-1519
“…was understood that aggressive dorsal resection and subsequent instability of the what is now termed keystone area can produce several undesirable complications: disruption of the dorsal aesthetic lines, inverted-V deformity, pollybeak, internal nasal valve collapse, and even saddle nose deformity.”
- Authors
- ONEAL, R., & BERKOWITZ, R.
- Affiliations
- American Society of Plastic Surgeons (US)
- Venue
- Aesthetic Surgery Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 1998-09
- Volume
- 18
- Issue
- 5
- Pages
- 370-371
- ISSN
- 1090-820X (ISSN-L)
- OpenAlex
- W1970060317
- Cited by
- 110
- References
- 0
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 2 · 2023: 10 · 2022: 14 · 2021: 11 · 2020: 11 · 2019: 7 · 2018: 9 · 2017: 4 · 2016: 2 · 2015: 8 · 2014: 3 · 2013: 6 · 2012: 3
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Aesthetic Surgery Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Cleft Lip and Palate Research
- Keywords
- upper lateral cartilages, rhinoplasty, septal reduction therapy, open rhinoplasty, nasal dorsum, cartilage preservation, secondary rhinoplasty
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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