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DOI: 10.1055/s-0037-159914
Dorsal Augmentation Using Autologous Costal Cartilage or Microfat-Infused Soft Tissue Augmentation
Publication History
Publication Date:
07 April 2017 (online)
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Abstract
Costal cartilage grafting is increasing in popularity with increased demand for augmentation rhinoplasty and increased need for grafting material for structure rhinoplasty techniques. Use of costal cartilage for dorsal grafting is both art and science. The art is demonstrated in the act of carving a dorsal graft that will reflect the actual contour of the nasal dorsum. The science is linked to the methodology of how the grafts are contoured to match the patient's desires and how the graft is fixed to the bony dorsum to minimize the risk of warping and displacement. Variations in dorsal graft design and methods of fixation are described. Use of the perichondrial interface between dorsal graft and perforated/rasped nasal dorsum acts to ossify the dorsal graft to the underlying bone, creating an immobile and natural appearing nasal dorsum. The fixation of the dorsal graft limits movement and hence decreases the likelihood of warping or deformity. Use of microfat in rhinoplasty has tremendous potential for camouflage and to promote healing of compromised tissues. Using microfat-infused soft tissue augmentation (MISTA), the surgeon is able to deliver microfat to an open surgical field, promote healing, and provide soft tissue augmentation. In this technique, microfat is injected into soft tissue carriers (perichondrium, temporalis fascia, etc.) and then implanted into the surgical field. MISTA has tremendous potential utility in many areas of cosmetic and reconstructive surgery.
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References
- 1 Toriumi DM, Asher SA. Primary rhinoplasty techniques: use of costal cartilage. In: Cobo R. , ed. Ethnic Considerations in Facial Plastic Surgery. Philadelphia, PA: Thieme; 2016: 196-217
- 2 Toriumi DM, Pero CD. Asian rhinoplasty. Clin Plast Surg 2010; 37 (02) 335-352
- 3 Toriumi DM. Discussion: use of autologous costal cartilage in Asian rhinoplasty. Plast Reconstr Surg 2012; 130 (06) 1349-1350
- 4 Erol OO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg 2000; 105 (06) 2229-2241 , discussion 2242–2243
- 5 Daniel RK, Calvert JW. Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg 2004; 113 (07) 2156-2171
- 6 Kelly MH, Bulstrode NW, Waterhouse N. Versatility of diced cartilage-fascia grafts in dorsal nasal augmentation. Plast Reconstr Surg 2007; 120 (06) 1654-1659 , discussion 1654–1659
- 7 Tasman AJ. Advances in nasal dorsal augmentation with diced cartilage. Curr Opin Otolaryngol Head Neck Surg 2013; 21 (04) 365-371
- 8 Tasman AJ, Diener PA, Litschel R. The diced cartilage glue graft for nasal augmentation. Morphometric evidence of longevity. JAMA Facial Plast Surg 2013; 15 (02) 86-94
- 9 Kridel RW, Ashoori F, Liu ES, Hart CG. Long-term use and follow-up of irradiated homologous costal cartilage grafts in the nose. Arch Facial Plast Surg 2009; 11 (06) 378-394
- 10 Lefkovits G. Irradiated homologous costal cartilage for augmentation rhinoplasty. Ann Plast Surg 1990; 25 (04) 317-327