Long-Term Results and Refinement of the Turkish Delight Technique for Primary and Secondary Rhinoplasty: 25 Years of Experience

Overview

Any cartilage graft can eventually show through the skin, distort or be absorbed. In 1989 the author began wrapping finely diced cartilage in Surgicel, an absorbable surgical gauze, to create a smoother surface. This paper reports the long-term behaviour of that graft, selecting patients whose surgery was between 4 and 25 years earlier.

Sections of note

• 9,398 primary and secondary rhinoplasty patients treated over 25 years by one surgeon.
• Patients selected for this report were 4 to 25 years past surgery.
• The technique wraps finely diced cartilage in Surgicel, an absorbable material.
• The author states swelling resolves approximately 90 to 95 percent by one year, with complete resolution continuing until four years, which is why longer follow-up was sought.
• The graft is reported free of the late visibility complication seen with other tip grafts.
• Long-term results from 4 to 25 years are described as very satisfactory with an acceptably low complication rate. Level of evidence 4, therapeutic.

What it means for a patient

• Grafts becoming visible under the skin years later is a real problem, and this technique is presented as avoiding it by using many small pieces rather than one solid block.
• The observation that swelling continues to settle for up to four years sets expectations for how long a nose keeps changing.
• Follow-up spanning 25 years is far longer than most rhinoplasty studies achieve.
• Single surgeon, no comparison group, and the abstract gives no complication rate, no revision rate and no number of patients actually assessed at long follow-up, so the favourable claims are not quantified.

Why this paper matters

Diced cartilage techniques are now widely used, and this series is one of the origins of that approach. Twenty-five years of one surgeon's experience is a rare source of long-term data. What it does not provide is the numbers needed to compare against solid or crushed grafts.

Terms

• Diced cartilage: cartilage chopped into small pieces so it moulds smoothly beneath the skin.
• Surgicel: an absorbable surgical gauze, used here to wrap the diced cartilage.
• Late show: a graft becoming visible through the skin months or years after surgery.
• Absorption or resorption: gradual loss of grafted tissue as the body reabsorbs it.
• Edema: fluid swelling in tissue.