title: A double-layered, stepped spreader graft for the deviated nose.
abstract: BACKGROUND
  In deviated noses, a beveled hump resection is recommended to preserve the shorter nasal wall. Even with this precaution, in some patients, the shorter wall does not reach the planned dorsal level when the lateral wall is transposed toward the midline after the lateral osteotomy.
  
  
  METHODS
  A double-layered, stepped spreader graft was used on the shorter wall side to construct symmetrical lateral nasal walls. The composite graft was constructed by fixing a smaller cartilage graft to the side of the dorsal border of a slightly larger than normal standard spreader graft. The smaller graft component adds height to the shorter lateral wall while the larger one functions as a usual spreader graft.
  
  
  RESULTS
  Stepped spreader grafts were used in 4 primary and 2 secondary rhinoplasty cases. All compound grafts were harvested from the septal cartilage except for one of the secondary cases, in which auricular cartilage was used. Two patients received a usual spreader graft on the contralateral side. Postoperatively, none of the patients exhibited significant recurrent deviation, and acceptable symmetrical dorsal esthetic lines were obtained in all patients.
  
  
  CONCLUSIONS
  This technique should be considered whenever the height of the lateral wall is shorter than desired after centralization of a deviated nose. Reconstruction of the shorter wall by adding height with a stepped spreader graft results in a more stable dorsum that resists relapse. Dorsal esthetic lines can also be reconstructed at the same time.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Celal Bayar University, Manisa 45010, Turkey. ahmetseyhan@hotmail.com
authors.forename: Ahmet
authors.initials: A
authors.lastname: Seyhan
authors.forename: Sema
authors.initials: S
authors.lastname: Ozden
authors.forename: Melike
authors.initials: M
authors.lastname: Gungor
authors.forename: Diren
authors.initials: D
authors.lastname: Celik
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009666:Nose / Q000601:surgery*; D012225:Rhinoplasty / Q000379:methods*; D019737:Transplants; D055815:Young Adult