Middle vault and dorsum spreader or spacer grafting is an essential tool in structure, ethnic, custom, revision and reconstructive rhinoplasties,whenever the nasal wall upper lateral cartilages collapse down to the soft cartilaginous septum, the dorsum is pinched, there is inverted V deformity, the dorsum has hourglass shape or is excessively narrow, there is a pinched nasal valve, the nasal pyramid needs stabilization, dorsum onlay grafts are unstable, etc, being the ideal donor sites the nasal septum, ear concha and the rib, with or without temporalis fascia camouflage grafting to hide its visibility in thin skin noses.
It is considered a highly demanding technique of high difficulty, long consuming in the operating room and pretty much artistic in terms of its versatility, allowing full deployment of creativity reshaping noses.
This gesture can be done by either closed or open approach rhinoplasties, notwithstanding the open approach is a must of safety, reliability and precision for its execution.
Patients warning: only highly experienced surgeons who have underwent optimal training and have performed already a large number of closed and open approach structure and non structure rhinoplasties should execute high end rhinoplasty cases, should they feel capable and comfortable with the challenge.