Secondary rhinoplasty: management of the overresected dorsum

Daniel RK, Sajadian A.

What this paper says

The authors explain why they replaced solid dorsal grafts with diced cartilage wrapped in fascia, used alone or as the surface layer of a layered reconstruction, when rebuilding a bridge that a previous surgeon took down too far, and now use only the patient's own tissue; the abstract reports no counts.

Overview

A bridge that has been over-reduced needs to be built back up. The choice of graft depends on the indication: purely aesthetic contour, added height, or structural support. Materials and methods changed in the years before this article, notably fascia and diced cartilage. The authors set out how and why their own selection changed.

Sections of note

Review and technique article; the abstract gives no patient numbers or outcomes.
Indications for dorsal grafting are separated into aesthetic, augmentation and structure.
The authors replaced solid dorsal grafts with diced cartilage grafts.
Diced cartilage is used either alone within a fascia wrap or as the aesthetic contour layer over a composite structural reconstruction.
Alternative materials and techniques are analyzed to justify the change.
The authors currently use autogenous tissue only.

What it means for a patient

An over-scooped bridge can be rebuilt with the patient's own cartilage chopped fine and wrapped in fascia, which molds to shape and avoids visible edges.
When support is also missing, a solid structural graft is placed underneath and the diced cartilage forms the smooth top layer.
The abstract gives no figures on resorption, revision or satisfaction with this approach.

Why this paper matters

Daniel's group helped establish diced cartilage in fascia as the standard for dorsal camouflage and augmentation. This article documents the reasoning for abandoning solid grafts in revision dorsal work. Long-term volume retention is not quantified here.

Terms

Overresected dorsum: a bridge from which too much bone and cartilage was removed, leaving a scooped profile.
Secondary rhinoplasty: a repeat operation on a nose that has already had surgery.
Diced cartilage: cartilage cut into tiny cubes so it can be molded.
Fascia: the tough tissue layer over muscle, often taken from the temple to wrap diced cartilage.
Composite reconstruction: a layered rebuild combining a structural graft beneath and a contour graft on top.
Autogenous tissue: tissue taken from the patient's own body.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Any discussion of grafting the dorsum in secondary rhinoplasty must take into account the different indications (aesthetic, augmentation, and structure) as well as recent changes in materials and techniques (fascia, diced cartilage). We have placed solid dorsal grafts with diced cartilage grafts either as an isolated…”

Excerpt; the full abstract is on PubMed.