\s=b\More rhinoplastic surgeons are using the external (combination) rhinoplasty approach for selected patients. Although several large series report few complications, the initial experience of newcomers may be different. A series of 26 external rhinoplasty approaches was examined, representing the initial experience of supervised residents. The most common complication was incising the anterior margin of the lower lateral cartilage at the juncture of the lateral and medial crura. To prevent this problem, it is recommended that the skin be elevated off the lower lateral cartilages from both a medial direction up over the domes and a lateral direction downward. To repair this complication, a figure-of-eight suture is used to reapproximate the incision.

Morsellized autologous dermis is a filling agent which may be utilized to obliterate facial wrinkles (rhytides), folds, and acne scars. An animal investigation was undertaken to evaluate morsellized dermis as an autologous “liquid” graft. The grafted dermis (injected beneath the epidermis with a fine-gauge needle) was free of infection and cyst formation in the experimental animal (pig) study. This technique has been performed for several patients. No clinically apparent complications, i.e., cyst formation, have resulted.

\s=b\Using an experimental animal model, we studied the stability of the size (gross morphology) and structure (histomorphology) of the fascia autograft. Fascia from a rabbit's leg was grafted in the subcutaneous tissue of the ear and abdomen and also into the intra-abdominal cavity. The weight and size of the autograft were recorded during the study period. Our findings showed that the size of the autograft remained stable, but there was a substantial weight reduction. Microscopic examination of histopathologic sections disclosed that there was no inflammatory response to the fascia. It also appeared to maintain its histomorphologic structure. Clinical trials with patients receiving facial plastic surgery are also reported. We believe a fascia autograft can be used to augment facial areas. We base this conclusion on the findings from previous reports, our animal experiment, and clinical trials.