Overlay grafting for lateral nasal wall concavities.

One of the most difficult maneuvers in rhinoplasty is achieving a straight dorsum in the patient with a crooked nose. Often this deformity is a result of trauma involving the bony and cartilaginous vaults, resulting in nasal bone fractures and avulsion of the lateral cartilages into the nasal airway. Reduction of nasal bone fractures is fairly straightforward, but the repair of nasal cartilage trauma is more problematic. The cartilage of the nasal vault possesses fibrous attachments, which when disturbed, are difficult to reestablish. Overlay grafts are known to be effective in filling these defects and creating the illusion of a straight nose. In this series, during an 8-year period, 89 grafts were placed over lateral nasal wall concavities during rhinoplasty. Results after a minimum of 1 year follow-up are reviewed, as well as technique, materials, complications, revision rate, and patient satisfaction.