The mystery of all the different types of nose grafts

Do you get confused by all the different types of  nose grafts that are mentioned? Wonder where do they go, and how do they work? I'm not referring to where the source of origin for harvesting  are, like ear, septal, costal, calvarial, in cases of autologous grafts,  but referring to the actual names of the grafts relative to its location in the nose. For example: Columellar strut is a hidden graft that strengthens and supports the nasal tip. Spreader graft is another hidden graft, which supports the middle part of the nose. A graft is simply a piece of cartilage or bone that is used for some purpose in rhinoplasty. Each graft has a specific purpose. There are also tip grafts, batten grafts, strut grafts, dorsal augmentation grafts, rim grafts, lateral crural grafts, plumping grafts, caudal extension grafts, radix grafts, onlay grafts, shield grafts, etc.  Enough to get anyone confused and left scratching their head. Well here are some links that will help unravel this mystery. Grafts go by many names relating to their shape, size &/or locality in the nose.  A shield graft relates to the shape of the graft in the nasal tip lobule.. An "alar" batten graft relates more specifically to locality, but batten grafts can be placed in different area's. The website links are from  Dr. Anil R. Shah , Dr. Daniel Becker (See Chapters 8-12) , Dr. Naderi and Dr. William Portuese.  Kudos to these Doctors for including this valuable information.

http://www.revisionrhinoplasty.com/RhinoplastyManual/index.html 

http://www.shahfacialplastics.com/grafts.html

http://www.seattlesinusdoctor.com/facial_procedures.html

http://www.rhinoplastyspecialistsurgeon.com/ethnic-rhinoplasty/grafts-sutures-in-rhinoplasty/

http://archfaci.ama-assn.org/content/5/4/291.full

http://www.glasgoldgroup.com/tipgrafts_theireffectsontipposition_contour-03.html

If any of the above links are broken, please don't hesitate to let me know. 

Alar Batten Graft (green area) and Different Shield grafts

FREQUENTLY USED GRAFTS IN RHINOPLASTY: NOMENCLATURE AND ANALYSIS

Author: Alan Landecker M.D. Co Authors: C.Spencer Cochran, Dr. Jack Gunter

Introduction Over the past several decades, numerous grafting techniques have been developed to sculpt the nasal framework in primary and secondary rhinoplasty. However, surgeons have been confused by the significant variability related to the nomenclature, exact anatomical position, and clinical indications of each graft. In this paper, the most commonly utilized grafts (a total of 24 grafts will be presented; below are 6 examples) in modern rhinoplasty are comprehensively analyzed according to the aforementioned factors.

http://www.hitechbrasil.com.br/sbcp/anais/42/paginas/285.htm#1355

The Butterfly Graft

The "Butterfly Graft" is a functional nasal procedure that Dr. J. Madison Clark has helped to develop and refine. Dr. Clark teaches the procedure to other nasal surgeons locally, regionally, and nationally. 

The simplest way to describe the procedure is as an internal "Breathe-Right" strip. The graft is taken from the ear but doesn't change the shape of the ear appreciably. It is usually intended that the graft not change the appearance of the nose, but it can be performed along with procedures that improve the aesthetic appearance of the nose (rhinoplasty).

The procedure is usually done under general anesthesia and takes about an hour to an hour and a half.

http://www.nc-faces.com/the-butterfly-graft/

Seagull Wing Graft

A technique for the replacement of the lower lateral cartilages

Fernando Pedroza, MD; Gustavo Coelho Anjos, MD; Lucas Gomes Patrocinio, MD; Jose M.Barreto, MD; Jorge Cortes, MD; Suad H. Quessep, MD

The seagull wing technique is indicated in cases in which there are severe signs of overresection of the lower lateral cartilages. 

We describe our 20-year experience with the seagull wing technique, which is designed to replace the lower lateral cartilages and to reconstruct the nasal tip. This technique has the advantages of almost completely rebuilding the structure of the nasal tip, restoring the function of the external nasal valve, and effectively correcting a great variety of aesthetic deformities. 

http://archfaci.ama-assn.org/content/8/6/396.full 

Structural Approach to Endonasal Rhinoplasty
Anil R. Shah, M.D. and Philip J. Miller, M.D.
Includes Information on Extended Tip graft and Columellar strut
Abstract
The marriage of endonasal rhinoplasty with structural grafting has resulted in more consistent rhinoplasty results. The nasal base can be stabilized by tongue-in-groove techniques, a columellar strut, or extended columellar strut. The middle vault can be addressed with spreader grafts or butterfly grafts. Lower lateral cartilage weakness can be supported with alar batten grafts or repositioning of the lower lateral cartilages.
http://www.drphilipmiller.com/Assets/Structuralapproach.pdf

Confused about what's the difference between Lateral crural strut grafts and alar strut grafts? Or rim grafts and Alar batten grafts?
Dr. Naderi explains in simple terms. Alar strut grafts and Lateral crural strut grafts are same.  But Alar batten grafts are not the same. A "rim graft" sits along the alar rim (right at the margin just like it sounds) whereas a "alar strut graft" site higher OVER the lateral aspect of the Lower Lateral Cartilage. The rim graft supports the soft tissue rim (nostril) while the strut graft supports the LLC laterally and thereby supports the entire nostril sidewall, not just the rim. An alar batten graft is a longer grafts that sits UNDER the lateral aspect of the Lower Lateral Cartilage and extends to the body pyriform apperture to prevent collapse of the nostrils during forceful inspiration.
Here's some other diagrams displaying nasal grafts. Click for larger view