Spreader grafts (SGs) have been widely used for both aesthetic and functional reasons to prevent middle vault collapse and treat internal nasal valve insufficiency. The rationale of their use is represented by SG ability to push the upper lateral cartilages in the lateral direction, thus increasing the crosssectional area of the internal nasal valve and support the nasal dorsum. As originally described by Sheen, 1 SGs are placed into submucous tunnels on either side of the dorsal septal

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... e. The main problem with the use of SG is their precise fixation to the dorsal septal border. This can be easily achieved in open rhinoplasty, while in endonasal rhinoplasties, the difficulties in their fixation can be discouraging. [2] [3] [4] In the present report, we describe a new custom-made SG (the "rail spreader" [RS]) and the personal easy method of application of such graft in "endonasal" rhinoplasty. The technical details and results are reported along with the advantages of our technique over previously described approaches. This study was approved by the institutional review board of "Villa Donatello" Clinic.