Dorsal Width and Functional Outcomes with use of Autospreader Flaps in Cosmetic Rhinoplasty.

Abstract

Use of spreader grafts can help mitigate the risk of nasal valve dysfunction in cosmetic rhinoplasty but can also increase the width of the nasal dorsum, compromising cosmetic outcomes. Determine the cosmetic and functional outcomes in patients undergoing cosmetic rhinoplasty with prophylactic auto-spreader flaps. Patients who underwent cosmetic primary rhinoplasty with prophylactic auto-spreader flaps were identified. Functional outcomes were measured by comparing pre-operative Nasal Obstructive Symptom Evaluation (NOSE)and the Visual Analog Scale (VAS) scores to post-operative scores at 1 month, 6 months, and 1 year. Patient dorsal width was measured using patient photos obtained pre-operatively and at 1 month, 6 months, and 1-year post-operative. There were significant reductions in nasal width at the keystone area (p < 0.0001), with sustained changes through 1 year. Nasal width at the upper and lower lateral cartilages showed transient postoperative swelling at 1 and 6 months, normalizing by 1 year (p = 0.0011). While there was a 1 mm increase in width, at 1 year compared to pre-operatively, this was not statistically significant (p>0.05). Functional outcome, including NOSE scores and VAS scores peaked at 1 month, then improved to pre-operative scores by 1 year (p = 0.0003 and p = 0.0012, respectively). The prophylactic use of auto-spreader flaps in cosmetic rhinoplasty preserves nasal function without significantly widening the nasal dorsum and compromising cosmetic outcomes.