Facial plast Surg 2017; 33(02): 133-138
DOI: 10.1055/s-0036-1598016
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Midvault Reconstruction in Primary Rhinoplasty

Shannon Rudy1, Sami P. Moubayed1, Sam P. Most1
  • 1Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
Further Information

Publication History

Publication Date:
07 April 2017 (online)


The nasal midvault is an important consideration in rhinoplasty. This region is defined by the attachment of the upper lateral cartilages (ULCs) to the nasal bones superiorly and the cartilaginous septum medially. Inadequate management of the nasal midvault can have negative functional and aesthetic ramifications. Indications for midvault reconstruction in primary rhinoplasty include a narrow midvault, dorsal hump resection, a deviated midvault, and an asymmetric midvault, with an additional relative indication of zone 1 lateral wall insufficiency (LWI), defined as dynamic collapse of a weakened lateral nasal wall at the level of the ULC. Numerous techniques for midvault reconstruction have been described, dating back to Sheen's description of the spreader graft in the 1980s, which remains the gold standard for repair. Herein, the various indications for midvault reconstruction are described, along with a discussion of the most commonly used techniques for successful reconstruction.