title: Modifications to the Butterfly Graft Used to Treat Nasal Obstruction and Assessment of Visibility.
abstract: OBJECTIVE
  Graft visibility in the supratip region has been the main criticism of the butterfly graft. Because of the graft location, slightly unfavorable supratip fullness can occur, resulting in patient dissatisfaction with the cosmetic result.
  
  
  OBJECTIVE
  To describe the clinical outcomes and visibility of the butterfly graft after technique modifications.
  
  
  METHODS
  In this retrospective review of adults who had undergone primary or secondary rhinoplasty with butterfly grafting from July 1, 2013, through July 31, 2014, at a tertiary care center at an academic institution, an operative log and photographs were reviewed in an effort to analyze outcomes of butterfly graft use in rhinoplasty.
  
  
  METHODS
  Nasal obstruction and visibility of the butterfly graft.
  
  
  RESULTS
  Thirty-four patients were included in the case series (mean [SD] age, 46 [19.4] years; 23 women and 11 men). The mean (SD) length of the graft was 3.4 (0.5) cm, and the mean (SD) width was 0.9 (0.2) cm. A significant decrease was found in the Nasal Obstruction Symptoms Evaluation score after surgery (mean [SD] preoperative score, 69 [17]; mean [SD] postoperative score, 23 [24]; P < .001). In regard to appearance, 25 patients (74%) rated their appearance as improved or no changes, 6 (18%) as minimally worse, and 1 (3%) as much worse. Fifty-nine observers participated in the masked survey for the study. When the graft was present, observers detected it 59.7% (282 of 472 answers) of the time. When the graft was not present, its presence was suspected 36.5% (237 of 649 answers) of the time.
  
  
  CONCLUSIONS
  The modified butterfly graft is a longer and thinner graft than the originally described butterfly graft. It is still an effective tool in the treatment of nasal obstruction with acceptable visibility. In most cases, it is difficult for health care professionals to identify the presence of the graft.
  
  
  METHODS
  4.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Myriam
authors.initials: M
authors.lastname: Loyo
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Deniz
authors.initials: D
authors.lastname: Gerecci
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.affiliation: Department of Otolaryngology, Yale University, New Haven, Connecticut.
authors.forename: Melynda
authors.initials: M
authors.lastname: Barnes
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Selena
authors.initials: S
authors.lastname: Liao
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Tom D
authors.initials: TD
authors.lastname: Wang
mesh_terms: D004425:Ear Cartilage / Q000637:transplantation*; D004954:Esthetics; D005260:Female; D006801:Humans; D008875:Middle Aged; D015508:Nasal Obstruction / Q000601:surgery*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome