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Spare Parts in Rhinoplasty: Repurposing Scar Tissue as Autologous Tip Grafts
Shaishav Datta
*1, Matthew Morris
2, Alexia Lucas
2, Sophie C. Queler
2, Steven Hanna
3, David Mattos
4, Richard Reish
21Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, ON, Canada; 2Plastic Surgery, Manhattan Eye, Ear and Throat Hospital, New York, NY; 3Private Practice, Toronto, ON, Canada; 4Plastic and Reconstructive Surgery, Baptist Health South Florida, Miami, FL
Background: Revision rhinoplasty is challenging due to altered anatomy, limited graft availability, and a thinned soft-tissue envelope. Nasal tip onlay grafts are commonly used for contour refinement, but traditional graft options may require additional donor-site harvest. Scar tissue from prior surgery is routinely encountered in revision rhinoplasty and represents a potential autologous graft source.
Methods: A retrospective review was performed of all open rhinoplasty procedures by a single surgeon between May 2015 and August 2024 in which native nasal scar tissue was used as a tip onlay graft. Primary rhinoplasty patients, <12 months of post-operative follow-up, or alternative tip graft materials were excluded. Demographics and outcomes were collected, including post-operative infection and subsequent revision surgery. A secondary exploratory comparison was performed with patients who underwent tip grafting with mastoid fascia when scar tissue was inadequate.
Results: 2,755 charts were reviewed, with 734 revision rhinoplasty cases. 450 underwent scar tissue grafting with a mean follow-up of 22.8 months. Post-operative infection occurred in 6 patients (1.3%), all successfully managed with oral antibiotics. 13 patients (2.9%) underwent revision surgery, most commonly for under-projection. No cases demonstrated appreciable graft necrosis, resorption, or skin envelope compromise. Infection and revision rates were similar between scar tissue and mastoid fascia cohorts.
Conclusions: Autologous scar tissue provides a readily available, pliable, and biocompatible material for tip grafting in revision rhinoplasty. This technique eliminates donor-site morbidity and additional operative time while maintaining low infection and revision rates. Patients with minimal or poor-quality scar tissue, may require alternative graft sources.
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