Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty Utilizing Fat Transfer Combined with Platelet-Rich Fibrin

Abstract

A thin or damaged skin soft tissue envelope may cause concerns in primary and secondary rhinoplasty. During postoperative healing, unpredictable scarring and contraction may occur and lead to significant aesthetic and trophic sequelae. Besides a meticulous surgical technique, there are no reliable techniques to prevent long-term skin damage and shrinkage. Fat transfer with addition of platelet-rich fibrin (PRF) harbors the possibility of local soft tissue regeneration and skin rejuvenation through growth factors and mesenchymal stem cells. It may also facilitate the creation of a thin fat layer on the dorsum to prevent shrink-wrap forces and conceal small irregularities. The goal is to provide evidence for the feasibility, durability, and beneficial effect of diced macrofat transfer bonded with PRF on the nasal dorsum. We present the technique of fat transfer conjugated with PRF as a nasal dorsal graft. Clinical endpoints were the prevention of trophic disturbances and atrophy at a 1-year postoperative follow-up. We present the skin mobility test as a clinical indicator of a healthy soft tissue envelope. The presented case series consists of 107 rhinoplasties. Fat was harvested in the umbilical or costal region. PRF was created by centrifugation of autologous whole blood samples. Macrofat was diced, cleaned, and bonded with PRF. The compound transplants were transferred to the nasal dorsum. There were no perioperative complications or wound-healing issues. Mean follow-up was 14 months. Clinical inspection showed good skin quality and no signs of shrinkage, marked scarring, or color changes with positive skin mobility test in all patients. Survival of fat was confirmed by ultrasonography and magnetic resonance imaging. Diced macrofat transfer in conjunction with PRF to the nasal dorsum is a feasible and safe method. A beneficial effect on the soft tissue envelope is demonstrated as well as the prevention of shrink-wrap forces.

The Role of Autologous Fat Grafting in Rhinoplasty

“…59,64 Some supplements such as platelet-rich fibrin, as introduced by Kovacevic et al, can potentially increase the retention of the fat graft and its regenerative effect on the surrounding soft tissue. 61,65,67,75 These observations were also evident in vitro studies. 45,68,69 Moreover, it can prevent the shrink-wrap phenomenon and camouflage irregularities, particularly in thin-skinned patients.…”

“…55,61,62 Moreover, it also showed a decrease in bruising and edema formation postsurgery, improved SSTE quality, and a possible increase in diced cartilaginous grafts viability. [59][60][61]64…”

“…Fat grafting use in different forms, including en bloc fat, macrofat, microfat, and nanofat, has been growing incrementally in rhinoplasty surgery recently. 29,55,[59][60][61][62][63][64] The fat grafting has been mainly used for dorsal augmentation, camouflaging the nasal dorsum irregularities, and concealing nuances of osteotomy lines. This cushioning effect is beneficial in thin-skinned patients, in whom flaws of the osseocartilaginous framework can easily be seen on the outer surface of the SSTE.…”

“…28,[33][34][35] The regenerative effect of the fat grafts on the surrounding tissues makes it an ideal graft to improve the quality and soften the scarred SSTE. 61,[63][64][65][66] The regenerative effect of fat grafting is well established in the scar and chronic wound therapy of various soft tissues. 14,[16][17][18] Consequently, fat grafting was used based on this characteristic to improve the scarred nasal SSTE either through several fat injections preoperatively or within the surgery.…”

A 3-Level Impaction Technique for Dorsal Reshaping and Reduction Without Dorsal Soft Tissue Envelope Dissection

“…The avoidance of damaging the dorsal skin envelope is a major advance. As reviewed by Kovacevic et al 27 a damaged soft tissue envelope is a major concern following primary rhinoplasty and a major challenge in secondary cases. Unpredictable scarring and contraction does occur and can lead to significant aesthetic and trophic sequelae.…”