Dorsal Augmentation

'Mini DC-F' in rhinoplasty: Diced cartilage and fascia grafts with the temporalis fascia dissected along its width - A technical note

In rhinoplasty, diced cartilage with fascia (DC-F) is a commonly used technique to enhance dorsal projection and achieve a smooth dorsum. We have developed a modified technique by dissecting the thickness of the fascia along its width, called "Mini DC-F". This method allows for effective camouflaging of dorsal irregularities and provides a slight increase in dorsal height. This simplified and less invasive technique not only reduces operative time but also enhances the surgeon's ability to achieve a refined aesthetic result. This technique offers an intermediate option in the surgical arsenal, bridging the gap between pure camouflaging methods and those aimed at significant dorsal augmentation.

Saddle Nose Deformity Reconstruction with a Allograft Bone

OBJECTIVE

Providing lasting cosmetic and functional results for patients with saddle nose deformity with allograft.

METHODS

This report describes experience with using a of freeze-dried allograft bone allograft in 58 patients who underwent dorsal augmentation over 5-year period (2018-2023). Thirty-eight patients had saddle-shaped deformity of the nose, and 16 patients had post-traumatic cases with saddle nose deformities. All patients underwent a clinical examination using computed tomography. Before surgery using a 3D model, the graft was contoured according to the shape of the nasal defect. The grafts were installed using a closed approach and were placed under the periosteum of the bone. Using lateral photographs, anthropometric measurements of the nose were taken before and after surgery to assess aesthetic outcome after surgery. To assess the results of aesthetic rhinoplasty (UQ), the Portuguese version of the Utrecht Questionnaire was used, which contains a visual analogue scale (VAS) on a 5-point Likert scale.

RESULTS

A total of 56 patients were satisfied with the results of the surgical procedure. No complications or major graft resorption was observed. An analysis comparing preoperative and 1-year follow-up data using 3D scanning showed a significant increase in dorsal height without dorsal expansion. After rhinoplasty, the mean visual analog scale (VAS) aesthetic score improved significant from 2.3 preoperatively, 3 months postoperatively 8.4, and 8.9 1 year postoperatively.

CONCLUSION

The use of freeze-dried allograft bone is a useful method of dorsal augmentation in rhinoplasty without donor site complications.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The current techniques in dorsal augmentation rhinoplasty: a comprehensive review

BACKGROUND

An essential aspect of rhinoplasty is the enhancement of the nasal dorsal contour by performing dorsal augmentation (DA) rhinoplasty. A wide range of techniques are available for DA as the demand for aesthetic nasal refinement grows. This review aims to provide a comprehensive overview of the current techniques used in DA rhinoplasty.

MAIN BODY

Research articles on DA rhinoplasty techniques were identified through a comprehensive literature search. Scopus, PubMed, and Web of Science were used as electronic databases. Each database was searched for articles published since its inception. DA rhinoplasty techniques were examined in this literature review. Methodological quality was assessed for the selected studies, and data was extracted to examine materials used, surgical approaches, and reported outcomes for each technique. Various DA methods, including autologous grafts and synthetic implants, are examined in-depth in this review. Comparing approaches can help better understand their respective advantages and limitations.

CONCLUSION

A wealth of techniques is available for DA rhinoplasty, each with advantages. Patients' nasal anatomy, desired outcomes, and potential risks must be considered by surgeons when determining their surgical approach. DA methods continue to evolve rapidly, creating a need for a thorough understanding of the current landscape to make informed decisions.

Outcomes of Diced Cartilage Dorsal Augmentation in Dorsal Aesthetic Deformities

Objective: To investigate the effectiveness of diced cartilage graft for dorsal augmentation in rhinoplasty. Methods: In a retrospective study, patients who underwent rhinoplasty with dorsal augmentation using diced cartilage graft from June 2017 to December 2021 were identified. Patients with complete preoperative and at least one postoperative Standardized Cosmesis and Health Nasal Outcomes Survey-Cosmesis (SCHNOS-C) and visual analogue scale (VAS) scores were included in the study. Postoperative periods were classified into ≤6 and >6 months. Mean preoperative outcome scores were compared with postoperative scores utilizing a Paired t-test, and postoperative scores were compared utilizing a Wilcoxon rank-sum test. Results: A total of 71 patients with a median age of 36 years, range (18-74) fit inclusion criteria. Majority were female patients 49 (69%). The postoperative period ranged from 17 days to 3.5 years. The mean follow-up period (standard deviation) for ≤6 and >6 months was 2.8 (1.5) and 14.2 (6.3) months, respectively. A decrease in mean SCHNOS-C, SCHNOS item 8, and an increase in VAS scores (p < 0.0001) were seen at both postoperative time periods compared with preoperative levels. Conclusion: This study demonstrates that dorsal augmentation with diced cartilage graft is an effective technique in correcting dorsal aesthetic deformities.

Immediate Nasal Reconstruction in Management of Infected Nasal Alloplast and Allografts: A Case Series

BACKGROUND

The use of alloplastic and allogenic nasal implants is widely popular in rhinoplasty. However, the use of these materials is accompanied by a risk of infection and extrusion. Traditionally, management of these complications is performed in a dual-staged fashion. First, the implant is removed and infection is controlled, then a delayed reconstruction is performed. However, scarring and soft tissue contracture make a delayed reconstruction challenging, and optimal aesthetic outcomes are difficult to achieve. This study was designed to evaluate the outcomes of immediate nasal reconstruction following removal of an infected nasal implant.

METHODS

A retrospective chart review was performed of all patients who had infected nasal implants and underwent simultaneous removal and immediate nasal reconstruction with autologous cartilages (n = 8). Data collected included patient age, race, pre-operative presentation, intraoperative surgical maneuvers, and post-operative outcomes and complications. Post-operative results were used to measure success of the single-staged method.

RESULTS

Follow-up ranged from 12 to 156 months with mean 84.4 months of the eight patients who were evaluated in the study, none had any major post-operative complications that required revision or reconstruction. All of the patients had marked improvement in nasal form and function. Six of the eight (75%) patients reported excellent aesthetic outcomes; two (25%) requested revisional surgeries for aesthetic concerns.

CONCLUSION

Low complication rates and excellent aesthetic outcomes are possible in immediate autologous reconstruction following removal of an infected nasal implant. This is an alternative approach that obviates the inherent problems of a traditional delayed reconstruction.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ..

Biological Changes of Autologous Auricular Cartilage in Rhinoplasty

Autologous auricular cartilage is used extensively as a good graft material in rhinoplasty. In this study, clinical specimens from patients who underwent revision rhinoplasty with auricular cartilage grafts were collected to compare the changes before and after auricular cartilage transplantation with the use of histologic, immunohistochemical, and quantitative assays. Patients who underwent revision rhinoplasty from 2018 to 2022 were analyzed. Fresh auricular cartilage left after surgery and auricular cartilage graft tissue were examined and compared. Compared with fresh auricular cartilage, local fibrosis was seen in the transplanted auricular cartilage with a slight decrease in elastic fibers, type II collagen, and extracellular matrix secretion. Quantitative assays showed a decrease in glycosaminoglycan, DNA, and total collagen content in the transplanted auricular cartilage tissue. The results of the study suggest that the histologic characteristics, cell functionality, and biochemical composition of the grafted cartilage changed to a certain extent after autologous auricular cartilage graft rhinoplasty. These results provide insights into the selection of graft/filler materials for rhinoplasty and what changes to expect.