Dorsal Augmentation Using Glued Diced Costal Cartilage With Fascial Cap in Asian Nose

The Problem

Small nose.

The Background

Asian people tend to have weak cartilage framework and thick skin, which is commonly associated with low dorsal height and poor tip projection. Due to its strength and capability of providing ample graft material, autologous costal cartilage plays an important role in Asian rhinoplasty. Costal cartilage is particularly useful in patients whose nose has an underprojected and weak lower two-thirds, where the reinforcement using extended spreader grafts and a caudal septal extension graft is the mainstay in projecting and enhancing support of the nasal tip. After rebuilding the cartilaginous framework, dorsal augmentation should be done, adjusted to the new height of the tip. Dorsal augmentation using solid block costal cartilage has been the most common way of performing dorsal augmentation. However, monobloc dorsal onlay grafts using costal cartilage frequently result in complications such as warping, graft visibility, and surface irregularity. To avoid these problems, several techniques have been developed. Diced costal cartilage was introduced by Peer in 1954 and has been widely used with many different wrapping materials such as fascia, AlloDerm (LifeCell Corporation, Brenchburg, New Jersey), and oxidized cellulose polymer (Surgicel, Johnson & Johnson Medical, Inc., Arlington, Texas). Diced cartilage fixed and shaped with fibrin glue is an alternative method of dorsal augmentation that has gained wide popularity. The authors use costal cartilage for dorsal augmentation in a slightly different way. We use glued diced costal cartilage, half covered with fascia or perichondrium, with no wrapping. Using the half-covered dorsal implant can reduce the amount of fascia needed to wrap around the diced cartilage. In order to ease the shaping of the implant, we use a specially designed cartilage mold. Here we introduce our approach for a typical augmentation rhinoplasty using costal cartilage.

The Indications

Augmentation rhinoplasty consists of cartilage framework reconstruction with a combination of extended spreader grafts and caudal septal extension grafts, with or without tip grafting, and dorsal augmentation using glued diced cartilage fashioned with our cartilage mold. The indications for this surgery are patients with a short nose, saddle nose, deviated nose with a flat nasal dorsum, and a small and flat nose.

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