Rhinoplasty: Aesthetic Augmentation With Improvement of Dorsal Aesthetic Lines.

Abstract

BACKGROUND\nCamouflage of nasal dorsum, aesthetic augmentation and highlighting the dorsal aesthetic lines are essential elements in modern rhinoplasty. Numerous techniques have been utilized including deep temporal fascia, rectus abdominis fascia, and diced cartilage in fascia (DC-F). Despite their wide spread adoption, technical challenges remained, especially when utilized for aesthetic purposes.\n\n\nOBJECTIVES\nThe paper details the use of fascia (F) and diced cartilage in fascia grafts (DC-F) for aesthetic dorsal refinement in primary and secondary cases. One of the main goals was to achieve ideal dorsal aesthetic dorsal lines rather than just volume augmentation.\n\n\nMETHODS\nWe used grafts from the deep temporalis fascia (F) and rectus abdominis fascia (RF) in 4 configurations: 1) single layer, 2) double layer, 3) full length diced cartilage in fascia grafts (DC-F), and 4) partially filled - segmental DC-F grafts. Technical refinements included careful determination of dimensions and meticulously suturing to the dorsum at appropriately 10 points to prevent graft displacement.\n\n\nRESULTS\nWe report our experience: 146 clinical cases over 35 months from January 2017 to December 2019. The patients were divided for 4 groups depending on which type of graft was used.\n\n\nCONCLUSIONS\nUse of autogenous deep temporal fascia, rectus abdominis fascia, and diced cartilage in fascia (DC-F) to camouflage dorsal irregularities, to highlight dorsal aesthetic lines, and to aesthetically augment either the entire nasal dorsum or its individual parts. Optimization of cutting, stitching, filling the graft, careful fixation of these grafts on the nasal dorsum, significantly increases the predictability of these techniques and minimizes problems.