“Split” Umbrella Onlay Grafts for the Correction of Upper Lateral Cartilage Defects

Abstract

Multiple techniques have been proposed to correct cartilaginous asymmetries and defects in the nasal pyramid. Some have proven to be more successful maneuvers than others. Among the more successful are the septal—upper lateral spreader grafts popularized by Sheen. However, some upper lateral defects have proven to be incompletely correctable by this technique. This is especially the case in secondary rhinoplasty, where excessive upper lateral cartilage may have been initially resected, resulting in a step-off defect vis-a-vis the nasal bone and a depression lateral to the dorsal profile, frequently associated with a defect in the nasal valve. “Split” umbrella onlay grafts have proven to be a successful technique to correct these defects in our hands in over 350 cases performed from 1987 through 1992. Morselized alar or septal cartilage was employed to correct upper lateral defects in the primary rhinoplasty group. Contoured auricular cartilage grafts proved to be more successful in the secondary rhinoplasty or the badly traumatized nose. Valvular competence was maintained or improved in all cases. This easily performed technique is deserving of more widespread application.