Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty Utilizing Fat Transfer Combined with Platelet-Rich Fibrin

Overview

Thin or damaged skin over the nose causes problems in both first time and revision rhinoplasty, because unpredictable scarring and contraction during healing can produce visible consequences. The authors state that apart from careful technique there are no reliable ways to prevent long term skin damage and shrinkage. They combined transferred fat with platelet rich fibrin, a concentrate made from the patient's own blood, and placed it on the bridge.

Sections of note

• Case series of 107 rhinoplasties; mean follow up 14 months.
• Fat was harvested from the umbilical or rib region.
• Platelet rich fibrin was produced by centrifuging the patient's own whole blood.
• Fat was diced, cleaned and bonded with the fibrin before transfer to the nasal bridge.
• There were no perioperative complications and no wound healing problems.
• Clinical inspection showed good skin quality with no shrinkage, marked scarring or colour change, and a positive skin mobility test in all patients.
• Survival of the transferred fat was confirmed by ultrasound and magnetic resonance imaging.
• Clinical endpoints were prevention of tissue disturbance and wasting at one year.

What it means for a patient

• A thin fat layer on the bridge is intended to cushion the skin and hide small irregularities.
• Imaging confirmed the fat survived rather than being absorbed, which is the usual concern with fat grafting.
• There was no control group, so the claim that shrinkage was prevented has no comparison.
• Assessment was by clinical inspection by the treating team rather than blinded raters or patient questionnaires.

Why this paper matters

Skin contraction over a rebuilt framework is a recognized cause of poor results in thin skinned and revision noses, and no established prevention exists. This series reports a biological approach with imaging confirmation of graft survival. Whether it prevents contraction better than technique alone is untested.

Terms

• Soft tissue envelope: the skin, fat and muscle covering the nasal framework.
• Platelet rich fibrin: a concentrate spun from the patient's own blood, containing growth factors.
• Diced macrofat: fat cut into small pieces so it can be spread as a layer.
• Shrink wrap forces: the tendency of healing skin to tighten around the framework beneath it.
• Skin mobility test: a clinical check of whether the skin still slides freely over the nose.
• Atrophy: thinning or wasting of tissue.