Using Dermofat Grafting in Revision Rhinoplasty

Overview

When artificial implants cause complications, surgeons turn to the patient's own tissue, including dermofat, meaning a graft of deep skin layer with attached fat. The problems with dermofat are absorption, difficulty shaping it, and injury at the donor site. This study presents surgical techniques intended to address those problems. Patients grafted between January 2015 and October 2019 were reviewed retrospectively, with primary rhinoplasty cases excluded.

Sections of note

• Retrospective review of 331 dermofat grafting cases in revision rhinoplasty; EBM level IV.
• The mid sacral dermis was chosen as the main donor site because its dermal layer is thickest.
• Fat was cut in a wedge shape during harvest to reduce flap tension and dead space.
• A molding technique was used to improve graft shape and height and to reduce absorption.
• Three rhinoplasty surgeons blinded to the study purpose compared before and after photographs.
• Twenty five cases underwent revision: 5 for over absorption, 1 for over correction and 9 for deviation.
• Donor site problems requiring revision were a widening scar in 1 case and wound breakdown in 8.
• One case developed an inflamed sinus formation.

What it means for a patient

• Dermofat is used to add soft bulk and cover the framework, particularly after implant problems.
• The graft is taken from the lower back near the sacrum, leaving a scar there.
• Complications occurred at both sites, with wound breakdown at the donor area the most frequent donor problem.
• This is a retrospective single centre series with no comparison group and no stated follow up duration.

Why this paper matters

Revision rhinoplasty after implant complications often needs soft tissue rather than more cartilage, and dermofat is a main option. This series reports its failure modes across a large number of cases. Whether the described molding technique actually reduces absorption is not tested against an alternative.

Terms

• Dermofat graft: a piece of deep skin layer with attached fat, moved to add soft bulk.
• Alloplastic material: an artificial implant rather than the patient's own tissue.
• Dermis: the thick layer of skin beneath the surface.
• Sacral: relating to the sacrum, the bone at the base of the spine.
• Dead space: an empty pocket left under a wound where fluid can collect.