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

Figure 5. The diced cartilage wrapped in fascia is adjusted to account for the nasal starting point, dorsal aesthetic line, and supratip break

Figure 6. Fenestrations are created throughout the diced cartilage fascia to allow for free effusion of any remaining fluid to promote
earlier vascular and fibrous ingrowth

along the supratip break with a 5-0 vicryl, creating a portion of the construct filled with diced cartilage, and
a tab of fascia without cartilage used to secure the complex to the supratip and tip complex, as shown in
Figures 4 and 5.

A needle is used to create fenestrations throughout the DCF, to allow for free effusion of any remaining fluid
within the construct, and to promote quicker fibrous and vascular ingrowth into the graft [Figure 6]. Corset
sutures are placed to taper the graft from a cylindrical shape to a more parabolic shape, consistent with the
appearance of the desired dorsal aesthetic lines [Figure 7]. These corset sutures may be used to great effect to
finely calibrate the proportions and dimensions of the graft.

When the final shape has been achieved, the DCF may be placed again along the dorsum of the nose to
evaluate the size and shape one final time prior to placement. Deficiency or excess volume and height may
be adjusted by making a small incision along the DCF and removing or adding diced cartilage as deemed
necessary.

The DCF is secured along its cephalic and caudal ends, and its body shaped by casting. A percutaneous
suture is placed through the marked starting point, and secured to the cephalic end of DCF. In cases of
excessively wide skin dissection and a resultant large dorsal pocket - such as in removal of a previous
implant or graft, multiple percutaneous sutures may be placed to allow for more secure fixation. Along the
caudal aspect of the construct, the fascia is secured to the supratip and over the tip complex. The nasal skin
envelope may then be re-draped and the shape of the dorsum evaluated.