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Surgical Pearls
Nov/Dec 2018

Modification of the Butterfly Graft

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
JAMA Facial Plast Surg. 2018;20(6):509-510. doi:10.1001/jamafacial.2018.0686

The butterfly graft is a surgical technique using auricular conchal cartilage to reinforce the internal nasal valve in patients with nasal valve collapse. The graft is harvested from the conchal bowl and secured over the caudal portion of the upper lateral cartilages and under the cephalic margin of the lower lateral cartilages.

The concept of the butterfly graft was first described by Hage1 in 1965 and was later modified by Walter2 in 1972 and Stucker and Hoasjoe3 in 1994. A modern version was popularized after reported success in revision rhinoplasty in 2002 by Clark and Cook4 and primary rhinoplasty in 2009 by Friedman and Cook.5 The technique has since undergone modification to address some of the potential complications of the graft, as described by Loyo et al6 (Figure 1). The modified butterfly graft (hereafter referred to as “butterfly graft”) addressed the primary concern of graft visibility in the supratip region by making the graft longer, narrower, and thinner. Although it can be placed through an endonasal approach, herein we describe placement through an external approach (Figure 2 and Video).