Crushed Cartilage and Autologous Fat for Dorsal Nasal Refinement
Arvind U. Gowda, MD, Navid Pourtaheri, MD, PhD, Kitae E. Park, BA, Omar Allam, BS, Seija Maniskas, MD, Derek Steinbacher, MD.
Yale School of Medicine, New Haven, CT, USA.
BACKGROUND: Dorsal contour irregularities remain a potential undesirable sequela of rhinoplasty. Dorsal onlay grafts can prevent such irregularities by camouflaging this area. We describe a novel technique for dorsal onlay grafting utilizing crushed cartilage mixed with autologous fat. This study aims to objectively assess long-term graft retention and aesthetic outcomes with this technique. METHODS: Patients with >18 months follow-up who underwent primary open rhinoplasty including the described technique were reviewed. Three-dimensional photographs taken at multiple timepoints were overlaid with volumetric subtraction used to quantify graft retention. Rhinoplasty FACE-Q was completed by each patient and Rhinoplasty Assessment Scale Photographic (RASP) was completed by surgeon reviewers. Pre- and post-operative changes in dorsal height as well as RASP scores were compared with paired t-tests. Changes in BMI, dorsal volume, and dorsal height were compared with linear regression. P-values <0.05 were considered significant. RESULTS: Fourteen patients were included; mean age 32. Mean intermediate and final follow-up was 17.8 months and 28.9 months, respectively. There was no statistically significant dorsal height change (mean=0.0 mm, p=0.91) and minimal dorsal volume change (mean=0.02 cm3, range: -0.08 to 0.13). Patients reported a high degree of satisfaction with facial/nasal appearance and psychological/social functioning. There was a statistically significant improvement in nasal aesthetic scores (p<0.001) postoperatively. CONCLUSIONS: Crushed septal cartilage mixed with autologous fat is an effective option for dorsal nasal onlay in rhinoplasty and is associated with excellent graft retention, patient satisfaction, and nasal aesthetics.
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