Autologous Fascia Lata Graft for Contour Restoration and Camouflage in Tertiary Rhinoplasty

Abstract

Tertiary rhinoplasty is a surgical procedure to correct nasal deformities that have been developed after prior unsuccessful surgeries. Such surgery requires complicated manipulations and tissue grafting for proper restoration. In the current study, we report the use of fascia lata graft combined with cartilage grafts for contour restoring and camouflage. Twenty-three patients who had severe nasal deformities were included, of whom 14 were men and 9 were women. Their ages ranged between 24 and 34 years (mean, 29 y). All patients were twice previously operated on by surgeons other than the authors. An informed consent was obtained from all patients. After harvesting the costal cartilage, the fascia lata graft (mean size, 2-3 cm) was uniformly harvested from the right lateral thigh. Application of the fascia lata and the cartilage graft was achieved through the open rhinoplasty incision. The fascia lata was applied over the cartilage in the dorsal region in 20 patients (86.9%), applied over the reconstructed alar and dome area in the nasal tip in 8 patients (34.7%), and applied over both areas simultaneously in 4 patients (17.3%). Postoperative follow-up was between 14 and 35 months (mean, 24.5 mo); clinical evaluation, photographic documentation, and a questionnaire form related to donor-site morbidity and patient satisfaction were applied after 12 months of the follow-up period. Results showed that all patients had an improved aesthetic result, and no apparent irregularities were observed in the integument of the aesthetic lines. No complications or no requirement for revision surgery was observed later on. In conclusion, refinements of the nasal dorsum and the nasal tip in tertiary rhinoplasty are indeed important and difficult to be managed. Placing the fascia lata over the applied cartilage grafts provide a good cover that conceals the possible irregularities or distortions that may appear in the late postoperative period.

A Novel Method for Smooth Contouring of Nasal Tip

“…If tip grafting is necessary in a thin-skinned nose to provide the desired outcome (eg, in secondary rhinoplasty), the surgeon can also cover the leading edge of a carved tip graft with acellular dermis (Alloderm, LifeCell, Branchburg, NJ), perichondrium, or fascia, in addition to soft tissue. [10][11][12][13] All of these additional overlay graft material options and techniques have been used with varying success, but all have drawbacks and/or shortcomings. Some, such as dermal grafts, tensor fascia lata grafts, and temporal fascia grafts, must be harvested through a separate and visible skin incision.…”

“…[1][2][3] There are several types of tip grafts used to improve tip definition and lengthen the infratip lobe, thus enhancing tip projection. [4][5][6][7][8][9][10][11][12][13][14] Autologous cartilage grafts, which are inherently firmer in nature, often become visible after the resolution of postoperative edema and distort a previously favorable rhinoplasty outcome, especially when used in thin-skinned patients. 4 One of the associated complications includes long-term visibility in the form of a so-called ''tombstone deformity,'' which is used to describe a graft whose straight edges have become visible at the tip area resemble the appearance of a tombstone.…”

Use of the Autologous Membrane in Structured Rhinoplasty: An Alternative to Camouflaging and Filling

“…Techniques that use diced cartilage with or without membrane coverings, such as temporal or abdominal fascia or synthetic materials, show intercurrences such as hypocorrections and hypercorrections, infections (apart from hypertrophic scars in the donor sites), and the need for revisions, and a longer surgery period. 27 , 28 Filling-in using hyaluronic acid may have disadvantages, apart from the cost, the absorption, or, as an extreme complication, secondary skin necrosis, and vascular embolization. 29 …”

Utilization of Tutopatch® bovine pericardium xenograft for nasal dorsum augmentation in primary and secondary rhinoplasties

“…Another favorable autologous fascial option for use in rhinoplasty operations with or without cartilage support is the fascia lata. [10,11] It is thicker than all other autologous fasciae and this feature can be highly advantageous in camouflaging severe nasal dorsum deformities.…”