Page 43 - Read Online

Page 8 of 9 Wu et al. Plast Aesthet Res 2019;6:5 I http://dx.doi.org/10.20517/2347-9264.2018.74

DISCUSSION
Given the contemporary focus of minimizing complications and creating a life-long result, many rhinoplasty
surgeons have shifted towards exclusively using autologous grafts during dorsal augmentation. Diced
cartilage fascia techniques have proven attractive for a number of reasons, including their relative pliability,
wide availability of materials needed for the construct, and the perceived forgiving nature with regards to
contour irregularities.

Diced cartilage fascia techniques for dorsal augmentation in rhinoplasty and revision rhinoplasty have been
variously utilized and described for over half a century. Despite producing satisfactory results in many cases,
it has received criticism at times for creating a “sausage-like” appearance or an otherwise unnatural look to
the dorsum. Also despite its perception as forgiving, it does have a somewhat large inter-surgeon variance
with regards to aesthetic outcomes. The term is broadly descriptive, and there remains a wide-range of ways
to execute it.

Contour irregularities remain the most common reason for surgeon and patient dissatisfaction after
dorsal augmentation using diced cartilage with fascia. Sub-optimal contours may manifest in the form of
convexities and concavities, over or under augmentation, deviation, asymmetries, and unnatural dorsal
aesthetic lines. Occasionally, natural variations in nasal skin envelope thickness and sebaceous qualities
between the dorsum, supratip, tip, infratip and columella, as well as scarring from previous surgeries,
may result in a less than ideal appearance to the nasal starting point, radix, dorsum, supratip break, nasal
tip, infratip lobule, and columella. Conservative management of minor contour irregularities with nasal
exercises (especially within the first month following surgery), and directed injections of kenalog and
5-fluorouracil, will successfully address many of the irregularities observed in the early post-operative
period. Persistent contour irregularities beyond post-operative edema involving coalesced diced cartilage
will infrequently warrant revision surgery to address.

This updated diced cartilage fascia technique seeks to eliminate variance and enhance precision to create
more predictable and consistently beautiful results. Placing greater emphasis on precision and a more
algorithmic approach to constructing the DCF graft may result in even improved outcomes for future
patients.

DECLARATIONS
Authors’ contributions
The authors contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Written informed consent was obtained for all patients.

Consent for publication
Written informed consent was obtained for all patient images.