Rhinoplasty: Aesthetic Augmentation With Improvement of Dorsal Aesthetic Lines

Overview

Hiding irregularities on the bridge, adding height, and defining the shadow lines that run down the nose are described as essential elements of modern rhinoplasty. Techniques include deep temporal fascia, rectus abdominis fascia and diced cartilage wrapped in fascia. The authors state technical difficulties remain, particularly when these are used for appearance rather than volume. The paper details their use in first time and revision cases.

Sections of note

• Case series of 146 clinical cases over 35 months from January 2017 to December 2019.
• Grafts came from deep temporalis fascia and rectus abdominis fascia.
• Four configurations were used: single layer, double layer, full length diced cartilage in fascia, and partially filled segmental diced cartilage in fascia.
• Patients were divided into four groups by graft type used.
• Technical refinements included careful determination of graft dimensions.
• Grafts were sutured to the bridge at approximately 10 points to prevent displacement.
• The stated goal was ideal dorsal aesthetic lines rather than volume augmentation alone.

What it means for a patient

• The fascia comes from either the side of the head or the abdomen, so there is a second surgical site.
• Fixing the graft at multiple points addresses the known problem of these grafts shifting position.
• The abstract reports no outcome measures, no complication rates and no follow up duration.
• No comparison between the four configurations is presented, despite patients being grouped by them.

Why this paper matters

Bridge augmentation and camouflage are the steps where thin skinned and revision noses most often fail visibly. This series describes a systematic approach with fixation as its central refinement. Without reported outcomes it establishes technique rather than effectiveness.

Terms

• Dorsal aesthetic lines: the two shadow lines running down the bridge from the brows to the tip.
• Fascia: a tough sheet of connective tissue, here used as a wrapping or covering graft.
• Diced cartilage in fascia: cartilage cut into small pieces and wrapped in a fascia sleeve.
• Deep temporal fascia: a fascia layer from the side of the head above the ear.
• Rectus abdominis fascia: the fascia sheet covering the abdominal muscles.
• Camouflage: concealing edges and irregularities with a soft covering layer.