The Evolution of the SPF-SPLF Graft in Rebuilding the Dorsum in Revision Rhinoplasty-an Update in an Over 300 Case Series.

[BACKGROUND] Reconstruction of the dorsum in revision rhinoplasty remains a challenge, requiring the balance of volume, proportion, and long-term stability. Traditional approaches-solid rib grafts or diced cartilage in fascia (DCF)-present limitations such as warping, poor definition, and surface irregularities.

[METHODS] Since its first application in 2017, the SPLF graft-a layered "sandwich" of perichondrium, rib lamination, and rectus fascia-has been progressively refined by the senior author. This construction is placed as a single unit onto the dorsum. In over 300 cases performed between 2021 and 2024, several variations in the SPLF's dimension, shape, and composition, including the addition of rib plaster, have allowed for high customization and optimization of dorsal contour and definition.

[RESULTS] The SPLF graft provided consistent dorsal height, smooth contour, and well-defined dorsal aesthetic lines (DALs), with outcomes indistinguishable from the native dorsum. No infections, graft warping, or significant long-term complications were observed in this series. The technique allowed intraoperative customization and demonstrated reliable long-term stability.

[CONCLUSIONS] The SPLF graft has become the preferred method for dorsal reconstruction in revision rhinoplasty within the senior author's practice, offering a highly adaptable and stable solution that combines structural support and aesthetic finesse. An algorithm for its application is proposed based on this extensive experience.

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