Rhinoplasty: Aesthetic Augmentation With Improvement of Dorsal Aesthetic Lines

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.

The Use of Posterior Auricular Fascia Graft (PAFG) for Slight Dorsal Augmentation and Irregular Dorsum Coverage in Primary and Revision Rhinoplasty: A Prospective Study

INTRODUCTION

Augmentation and coverage of irregularities of the nasal dorsum remain a challenge in rhinoplasty. Different techniques have been described in the current literature for this purpose. The aim of this study is to assess and illustrate the author experience and outcomes using the posterior auricular fascia graft (PAFG) for dorsal camouflage and augmentation in primary and revision rhinoplasty.

MATERIAL AND METHODS

A prospective bicentric study was conducted, including patients with slight dorsal deficiencies and/or with dorsal irregularities following hump resection, trauma or previous rhinoplasty receiving PAFG to improve the rhinoplasty outcome. To objectively assess the graft resorption rate, MRI was performed 2 weeks and 18 months after surgery. To investigate patient satisfaction, the preoperative and 1-year postoperative scores obtained using the rhinoplasty outcomes evaluation (ROE) scale were compared. The scores following a normal distribution obtained for each patient were compared using a paired t-test.

RESULTS

Forty-five patients were enroled in this study. Average follow-up duration was 35.4 months. Patients' age ranged from 17 to 57 years. No cases of infection or major graft resorption were observed. No postoperative scars were visible at the donor site. All patients were satisfied after surgery, and a statistically significant difference between pre- and postoperative scores (p<0.0001) was observed.

CONCLUSION

This study showed that PAFG is a reliable technique for dorsal camouflage and slight augmentation in primary and revision rhinoplasty. The procedure is safe, easy and quick and only requires a small learning curve.

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 .

Promotion of diced cartilage survival and regeneration with grafting of small intestinal submucosa loaded with urine-derived stem cells

Cartilage absorption and calcification are prone to occur after the implantation of diced cartilage wrapped with autologous materials, as well as prolong the operation time, aggravate surgical trauma and postoperative pain during the acquisition process. Small intestinal submucosa (SIS) has suitable toughness and excellent degradability, which has been widely used in the clinic. Urine-derived stem cells (USCs), as a new type of stem cells, have multi-directional differentiation potential. In this study, we attempt to create the tissue engineering membrane material, termed USCs-SIS (U-SIS), and wrap the diced cartilage with it, assuming that they can promote the survival and regeneration of cartilage. In this study, after co-culture with the SIS and U-SIS, the proliferation, migration and chondrogenesis ability of the auricular-derived chondrocyte cells (ACs) were significantly improved. Further, the expression levels of chondrocyte phenotype-related genes were up-regulated, whilst that of dedifferentiated genes was down-regulated. The signal pathway proteins (Wnt3a and Wnt5a) were also participated in regulation of chondrogenesis. In vivo, compared with perichondrium, the diced cartilage wrapped with the SIS and U-SIS attained higher survival rate, less calcification and absorption in both short and long terms. Particularly, USCs promoted chondrogenesis and modulated local immune responses via paracrine pathways. In conclusion, SIS have the potential to be a new choice of membrane material for diced cartilage graft. U-SIS can enhance survival and regeneration of diced cartilage as a bioactive membrane material.

Safety and Efficacy of Autologous Cartilage Graft in Augmentation Rhinoplasty

Augmentation rhinoplasty or commonly known as "nose jobs" is one of the most common plastic surgical procedures aimed to improve cosmetic appearance. This procedure is considerably safer, less time consuming with faster recovery and immediate cosmetic effect. This procedure needs of highly experienced and well-trained plastic surgeon. According to facial analysis you can select the type of rhinoplasty. Open discussion with the patient to select appropriate surgical technique and its possible risks with your plastic surgeon to ensure the highest level of safety and satisfaction. Autologous grafting materials are safe, efficient and also the first choice for rhinoplasty due to it can survive without a vascular supply, the resorption rate of cartilage is much lower than that of a bone graft. Autologous grafting materials are stable and resistant to infection and extrusion over time so, they are successfully used for dorsal augmentation. To perform successful augmentation rhinoplasty, surgeons should be highly experienced and well-trained and augmentation materials that are currently available and understand their risks, benefits and uses. Autologous cartilage graft regarded as the graft of choice in augmentation rhinoplasty because of their lower rate of infection, rejection, resorption, extrusion, donor site morbidity, easy reshaping.

Template for Diced Cartilage with Platelet-Rich Fibrin (PRF) in Rhinoplasty: An Easy Solution for Millimetric Camouflage of the Full Dorsal Esthetic Unit

Dorsal irregularities are one of the most common issues in modern rhinoplasty. Rhinoplasty surgeons propose placing interface grafts lining the hole dorsum to ensure a natural unoperated look. Diced cartilage embedded in Choukroun's platelet-rich fibrin (PRF) scaffold being one of the most recent innovations in the field. However, no method has been described to help with the creation of thin, malleable, and reproductive graft with millimetric precision using that technique. The senior author details his protocol and his experience with a newly developed template for the creation of reproductive grafts with standard size and thickness, using diced cartilage, injectable PRF (iPRF), and advanced PRF (aPRF), for full dorsal camouflage and lining in rhinoplasty. This retrospective case series was conducted to evaluate the results looking at the dorsal esthetic unit at a minimum of 6 months for patients who beneficiated from a millimetric dorsal augmentation from 1 to 2mm using diced cartilage with iPRF and aPRF. The author reports his experience with 54 cases operated from April 2018 to May 2022 using his newly developed template.The template is an innovative technique to allow faster and more reliable fabrication of soft grafts using diced cartilage with both iPRF and aPRF. This novel approach allows for millimetric dorsal augmentation from 1 to 2mm with great precision and high reproductivity with good esthetic outcome.

Composite Dorsal Augmentation

BACKGROUND

Dorsal augmentation is one of the most challenging procedures in rhinoplasty. Solid grafts and DC-F have been often used for this purpose with varying success. Warping, irregularities, and variability of final height are some of the potential pitfalls. The aim of this study is to assess the efficiency of our approach combining multiple grafts for nasal dorsal augmentation.

OBJECTIVES

We describe a technique using a composite dorsal augmentation that is a combination of a foundation layer using high spreader grafts plus a dorsal gap graft combined with a contour layer of three possible types of fascia or DC-F grafts. Combination of the two layers for the nasal dorsum can be varied to achieve the required height that corrects the patient's deformity and achieves the desired aesthetic goals.

METHODS

Fifty-one patients underwent dorsal augmentation with composite technique between 2017 and 2020 were retrospectively reviewed. A step-by-step algorithm is applied to achieve the required dorsal height.

RESULTS

The patients are divided into 3 groups, according to the type of contour graft used to increase the nasal dorsal height: double-layer fascia graft, Segmental DC-F or narrow thin Full-Length DC-F. Smooth continuity and increased projection of the nasal dorsum were achieved in all patients.

CONCLUSIONS

Composite dorsal augmentation is an effective technique for dorsal augmentations requiring 4mm or more of height increase. This technique allows to achieve dorsal augmentation using a combination of grafts from a single donor site together with camouflaging dorsal irregularities and highlighting dorsal aesthetic lines. This algorithm allows optimize greatly the aesthetic profile of our patients.