Spreader Grafts Versus Autospreader Flaps in Rhinoplasty: A Retrospective Comparison of Functional Performance, Midvault Aesthetics, and Patient Satisfaction

Objective The aesthetic and functional outcomes of modern rhinoplasty are profoundly affected by middle vault restoration. After dorsal reduction, the most common methods for restoring middle vault integrity include spreader grafts and autospreader flaps. This study compared spreader grafts and autospreader flaps with respect to functional performance, midvault aesthetics, patient satisfaction, and objective aesthetic outcomes, as measured by the Integrated Nasal Tip Aesthetic Score (INTAS). Methods Between January 2022 and December 2025, seventy patients underwent primary open rhinoplasty with middle vault reconstruction. This study was a retrospective cohort. One group of patients underwent spreader graft reconstruction (n=35), while the other group underwent autospreader flap reconstruction (n=35). Nasal Obstruction Symptom Evaluation (NOSE) was used to assess functional outcomes. The Rhinoplasty Outcome Evaluation (ROE), Midvault Aesthetic Score, and Integrated Nasal Tip Aesthetic Score (INTAS) were used to assess aesthetic outcomes. Additionally, we examined rates of revision surgery, complications, and patient satisfaction. Within and between groups, researchers assessed patients' outcomes before and after surgery. Results Nasal function and appearance improved markedly in both groups after surgery. Although the SG group had slightly lower postoperative NOSE ratings, both groups showed significant improvement. After surgery, the return on equity (ROE) was 9.04 ± 0.62 for the SG group and 8.55 ± 0.62 for the ASF group. Patients treated with spreader grafts had significantly higher mean postoperative INTAS scores (49.9 ± 3.6) than those treated with autospreader flaps (47.9 ± 3.8). The SG group also had higher Midvault Aesthetic Scores. Patient satisfaction was consistently high in both groups (8.98 ± 0.71 vs. 8.73 ± 0.82). Rates of complications and revisions were similar across the groups. Conclusion After rhinoplasty, patients achieved excellent outcomes with spreader grafts and autospreader flaps, both functionally and aesthetically. Although both methods restored middle vault function and improved patient satisfaction, spreader grafts yielded better aesthetic results, with higher scores on the Midvault Aesthetic Score, Return on Investment, and INTAS. These results provide additional evidence that spreader grafts can improve cosmetic accuracy without compromising functionality.