Improvement of Nasal Dorsal Onlay Graft Appearance after Augmentation Rhinoplasty with Costal Cartilage for Thin-Skinned Patients

Zheng R, Wang X, Wang H, You J, Xu Y, Zhang X, Guo J, Fan F.

PubMed 36071240 Publisher (DOI)Free full text (PMC)

What this paper says

In 52 thin skinned Chinese patients whose bridge graft edges were covered with perichondrium, satisfaction scores rose from 9.77 to 20.65, with one donor site problem and two cases of graft warping.

Overview

Concealing the bridge graft matters most in patients with thin skin, where edges show through. The authors present an improved method covering the two edges of the onlay graft with perichondrium, the membrane that covers cartilage, and assess its safety and effectiveness in augmentation rhinoplasty. Fifty two patients aged 18 to 42 having open augmentation rhinoplasty were included.

Sections of note

Study of 52 thin skinned patients; the journal assigns level of evidence IV.
Twenty four were first time cases and the rest were repeat operations.
Follow up ranged from 6 to 20 months.
Assessment used the Rhinoplasty Outcomes Evaluation scale and a visual aid scoring questionnaire.
Scores for each item improved significantly from before to after surgery.
Total Rhinoplasty Outcomes Evaluation scores were 9.77 plus or minus 3.18 before and 20.65 plus or minus 1.88 after.
Patients' own ratings of bridge improvement gave a high satisfaction rate.
One case of fat breakdown at the donor site and two cases of graft warping occurred, with no other major complications.

What it means for a patient

Thin skin shows the edges of a bridge graft, and covering those edges with the graft's own membrane is intended to soften them.
The perichondrium comes from the same rib harvest, so no additional donor site is needed.
Fifty two patients from one department with no comparison group is limited evidence.
Two of 52 grafts warped, which remains the main long term risk with rib cartilage.

Why this paper matters

Visible graft edges are the commonest cause of dissatisfaction after bridge augmentation in thin skinned patients. This technique uses tissue already harvested to camouflage them. Whether it outperforms fascia wrapping or diced cartilage has not been compared.

Terms

Dorsal onlay graft: cartilage laid on the bridge to add height.
Perichondrium: the membrane covering cartilage.
Costal cartilage: cartilage taken from the rib.
Thin skinned nose: a nose whose covering shows underlying edges and contours readily.
Warping: gradual bending of a cartilage graft after placement.
Fat liquefaction: breakdown of fat tissue at a wound, producing fluid.

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

Abstract

Background: The camouflage of the nasal dorsum is very important for thin-skinned patients. In this study, the authors presented an improved method for these patients and evaluated the safety and efficacy of this method in augmentation rhinoplasty.

Methods: Fifty-two thin-skinned nose Chinese patients, ranging in age from 18 to 42 years, who underwent open augmentation rhinoplasty with modified perichondrium on dorsal onlay graft were included in the study. Among these patients, 24 of them were primary cases, and the other cases were secondary. The Rhinoplasty Outcomes Evaluation (ROE) scale and Visual aid scoring (VAS) questionnaire were used to evaluate aesthetic outcomes.

Results: During the long-term follow-up (ranging from 6 to 20 months), the ROE scores of each item before and after surgery were statistically significant in our study. The total scores of the preoperative and postoperative ROE scale of the study were 9.77 ± 3.18 and 20.65 ± 1.88, respectively, which indicated reasonably high satisfaction. According to the VAS questionnaire, patients' own evaluations of the nasal dorsal improvement rendered a high satisfaction rate. One case of fat liquefaction at the donor site and two cases of warping occurred and no other major complications were encountered.

Conclusion: Covering the two edges of the graft with perichondrium on the onlay dorsal graft seems a convenient and effective method for thin-skinned augmentation rhinoplasty, which was the best choice for camouflage of the nasal dorsum in our department.

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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."

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