Various Applications of Deep Temporal Fascia in Rhinoplasty

Abstract

PurposeIn Asians, nasal dorsal and tip augmentation procedures are usually performed at the same time, and most dorsal augmentations use implants. In this study, dorsal augmentation was given by various types of grafts using deep temporal fascia (DTF) for primary rhinoplasty cases using only autologous tissues to improve the curve of hump noses and depressions. For secondary rhinoplasty cases, DTF was used to improve implant demarcation and transparency. Such effectiveness and utility of DTF is discussed.Materials and MethodsBetween May 2009 and May 2012, we performed rhinoplasty using DTF in 175 patients, which included 78 secondary surgery patients and 128 female patients. The mean age of the patients was 31.4. DTF was utilized with various types of grafts without implants to improve the curve in dorsal augmentation of hump noses and cases that required curve betterment. DTF was used to improve implant demarcation and transparency for secondary cases.ResultsThe mean follow-up duration was 1.5 years. Of the 175 patients, 81% were satisfied with the natural correction achieved, whereas 19% complained of undercorrection, which was resolved with additional surgery. No specific complications such as nasal inflammation or contractures were observed.ConclusionDTF can be used with various graft methods for correction of radix, dorsal, and tip irregularities. It can also be used to correct implant contour transparency in secondary rhinoplasty and thus may be considered as a useful supplementary graft material in rhinoplasty for Asians.

Comparison between Wrapping Dice Cartilage with Temporal Fascia and Wrapping in Alloderm for Dorsal Nasal Augmentation

“…However, the results of various studies have shown that a number of patients undergoing rhinoplasty required reoperation to resolve the anatomic and aesthetic drawbacks for a variety of reasons, and in a significant number of patients, the nasal dorsum reconstruction was the only way for the nose regeneration. [15][16][17][18] Consequently, using the diced cartilage wrapped by temporal fascia and alloderm are two commonly used methods, and the effect of both methods on the nasal dorsum resconstruction has been reported to be favorable, but the results of our study showed that using the temporal fascia covering was associated with the greater patient's satisfaction and more favorable height of the nasal dorsum. The use of diced cartilage greatly enhances the range of agmentation with autologous cartilage and is currently the preferred method for many surgeons.…”

“…The possible justification for the poorer results of using the alloderm is probably because of the more inflammatory reaction relative to the temporal fascia that is an autogenous tissue, and eventually led to greater absorption and irregularity following the use of alloderm for wrapping the diced cartilage. [15][16][17][18] Further, the penetration and permeability rates can be considered as the possible causes. Therefore, although the use of temporal fascia causes more time spent for the surgery and is associated with the morbidity of the donor area, the application results are more reliable, and hence, it is recommended to be preferably used.…”

“…The use of diced cartilage greatly enhances the range of agmentation with autologous cartilage and is currently the preferred method for many surgeons. [15][16][17][18] Therefore, it seems that the use of fascia is more desirable than alloderm derived from the cadaveric dermis, because it is from its own tissue, is more biocompatible with the patient, and is less likely to be absorbed. However, given the limitations of this study including the small sample size and lack of similar studies, it is recommended to conduct further studies in this area.…”

In vitro study on chondrogenic differentiation of human adipose-derived stem cells on treated bovine pericardium

“…Cartilage grafts for nasal dorsum contour seemed to be good at the time of the implant, but in thin-skinned individuals, as the skin gets thinner with age, the surface at the graft margin was reported to be apparent within 16 months after rhinoplasty. Therefore, an additional covering layer (usually a temporal fascia graft) is required, which will be placed under the skin and over the cartilage graft in order to bolster the thickness of the skin, minimize unwanted visible contour irregularities, and create natural aesthetic lines (Shiffman and Di Giuseppe, 2013;Ishii, 2014;Park et al, 2015). The temporal fascia grafts are fairly thin (from 1.60 to 1.90 mm), resulting in a successful and long-lasting dorsal contouring in rhinoplasty (Shiffman and Di Giuseppe, 2013).…”

Cadaveric study of deep temporal fascia for autologous rhinoplasty grafts: Dimensions of the temporal compartment in Asians

“…In rhinoplasty, the deep temporal fascia (DTF) is among the most important autologous graft materials used for various purposes. The DTF is generally utilized alone or as a fascia-wrapped cartilage graft in soft tissue reinforcement in reconstructive rhinoplasty [1,2] and for radix augmentation, correcting dorsal skin irregularities, and reinforcing the tip skin in aesthetic rhinoplasty [3][4][5]. Since the DTF is harvested from the same surgical field as rhinoplasty and features lower donor site morbidity rates, the DTF has advantages over other autologous tissues such as dermofat tissue [6], tensor fascia lata [7], and mastoid fascia [8].…”