Use of an Autologous Diced Cartilage Graft and Fat Graft Combination to Improve Regeneration in Rhinoplasty

Firat C, Bekircan K, Algan MF.

PubMed 33683385 Publisher (DOI)Free full text (PMC)

What this paper says

Across 228 cases mixing diced cartilage with fat on the nasal bridge, average bridge height dropped 1.4 mm after the first month, and cartilage cell viability measured 85 to 90 percent on tissue examination.

Overview

Many techniques aim to make a rhinoplasty result last. Cartilage can be diced and placed directly on the bridge or wrapped in a material first. The authors combined diced cartilage with fat grafts, proposing that the fat improves cartilage survival and acts as a glue holding the pieces together. Early and long term results were compared.

Sections of note

Analysis of 228 cases; the journal assigns level of evidence IV.
Photographs at 1 month, 6 months and 1.5 years were compared, and the areas that had settled on the bridge were measured.
Dorsal height was measured and compared across those time points.
Mean regression of the bridge after the first month was 1.4 mm.
The decrease in height between 1 and 6 months was significantly greater than between 6 months and the later period.
Rhinoplasty Outcome Evaluation scores averaged 45 before surgery and 81.5 after the first year.
Specimens from 6 patients were examined under the microscope; cartilage cell viability was 85 to 90 percent.

What it means for a patient

Most of the settling happened in the first six months, after which the bridge was relatively stable.
Fat was used to prevent cartilage edges and bone cut lines from being felt through thin skin.
Tissue was examined in only 6 of 228 patients, so the viability figure rests on a small sample.
There was no control group using diced cartilage without fat, so the claimed benefit of adding fat is not directly demonstrated.

Why this paper matters

Resorption and palpable irregularity are the two long standing objections to diced cartilage on the bridge, and this study measures both settling and cell survival. It follows patients to 1.5 years, longer than most such series. Whether the fat is responsible for the results remains untested.

Terms

Diced cartilage: cartilage cut into small pieces so it can be shaped like a paste.
Fat graft: fat taken from elsewhere on the body and transferred.
Dorsal height: the height of the nasal bridge.
Chondrocyte: the cell type that makes and maintains cartilage.
Resorption: gradual absorption and loss of graft material by the body.
Rhinoplasty Outcome Evaluation: a satisfaction questionnaire scored out of 100.

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

Abstract

Background: In rhinoplasty, many techniques are used to increase the permanence of the planned final shape of the nose. Cartilage grafts can be diced and applied directly to the nasal dorsum, or by wrapping with a material. We aim to show that mixing and using diced cartilage grafts with fat grafts can contribute to the viability of cartilage grafts by comparing our early postoperative and long-term results.

Materials And Methods: A total of 228 cases were analyzed. Postoperative 1-month, 6-month, and 1.5-year photographs of the patients were compared and the places that descended on the nasal dorsum were measured. In addition, dorsal height was measured and compared. Preoperative and postoperative first-year rhinoplasty outcome evaluation scales were performed. Specimens from 6 patients were examined histopathologically.

Results: After the first month, the mean regression in the dorsum was measured as 1.4 mm. The decrease in dorsal height between 1 month and 6 months was significantly greater than the decrease between 6 months and late periods. According to the rhinoplasty outcome evaluation (ROE) scale, the average preoperative score of the patients was 45, while the mean postoperative score was 81.5. The viability of chondrocyte cells was measured as 85-90% histopathologically.

Conclusion: This approach has been evaluated as an application that satisfies both the surgeon and the patient due to the advantages of fat grafts such as preventing the cartilage and osteotomy lines from being palpated in thin-skinned patients, holding the diced cartilage grafts together by acting as a glue, increasing the viability of cartilage grafts.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).