The Use of Posterior Auricular Fascia Graft (PAFG) for Slight Dorsal Augmentation and Irregular Dorsum Coverage in Primary and Revision Rhinoplasty: A Prospective Study

La Padula S, Pensato R, Pizza C, Rega U, D'Andrea F, Roccaro G, Ungerer L, Telesco F, Canta L, Longo B, Al-Amer R, Meningaud JP, Hersant B, Coiante E.

PubMed 37626136 Publisher (DOI)Free full text (PMC)

What this paper says

In 45 patients whose nasal bridges were covered with fascia taken from behind the ear, MRI at 18 months showed no major graft shrinkage, no infections and no visible donor scars.

Overview

Smoothing bridge irregularities and adding a small amount of height remain difficult problems in rhinoplasty, with many techniques described. The authors assessed the posterior auricular fascia graft, a thin sheet of connective tissue harvested from behind the ear, used for camouflage and slight augmentation in both first time and revision surgery. Graft survival was checked objectively with MRI.

Sections of note

Design: prospective study across two centres. Level of evidence II as assigned by the journal.
45 patients enrolled, ages 17 to 57. Average follow up 35.4 months.
Indications: slight bridge deficiency or irregularity following hump removal, trauma or previous rhinoplasty.
MRI was performed 2 weeks and 18 months after surgery to measure graft resorption objectively.
Satisfaction was measured with the Rhinoplasty Outcomes Evaluation scale before surgery and one year afterward, compared by paired t-test.
No cases of infection or major graft resorption were observed.
No postoperative scars were visible at the donor site behind the ear.
All patients were satisfied, with a statistically significant improvement in scores, p less than 0.0001.

What it means for a patient

The graft is harvested from behind the ear, where the scar is hidden in the crease, so no visible donor mark results.
Using MRI rather than photographs to check for shrinkage is a stronger method than most graft studies use.
The technique is for small corrections. It covers irregularities and adds slight height, not major augmentation.
Limits: 45 patients, no comparison group against other camouflage grafts such as diced cartilage or temporal fascia, and satisfaction reported as universal without a stated distribution.

Why this paper matters

Camouflage grafts on the bridge are widely used and rarely verified, since surface smoothness on photographs cannot show whether the graft is still there. Imaging the graft at 18 months addresses that directly. How it compares with the established alternatives remains untested.

Terms

Fascia: a thin sheet of fibrous connective tissue covering muscle.
Posterior auricular: located behind the ear.
Camouflage graft: a soft layer placed to hide underlying bumps or edges.
Dorsal augmentation: adding height to the bridge of the nose.
Resorption: gradual absorption and loss of graft volume by the body.
Rhinoplasty Outcomes Evaluation: a patient questionnaire scoring satisfaction with the nose.

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

Abstract

Introduction: Augmentation and coverage of irregularities of the nasal dorsum remain a challenge in rhinoplasty. Different techniques have been described in the current literature for this purpose. The aim of this study is to assess and illustrate the author experience and outcomes using the posterior auricular fascia graft (PAFG) for dorsal camouflage and augmentation in primary and revision rhinoplasty.

Material And Methods: A prospective bicentric study was conducted, including patients with slight dorsal deficiencies and/or with dorsal irregularities following hump resection, trauma or previous rhinoplasty receiving PAFG to improve the rhinoplasty outcome. To objectively assess the graft resorption rate, MRI was performed 2 weeks and 18 months after surgery. To investigate patient satisfaction, the preoperative and 1-year postoperative scores obtained using the rhinoplasty outcomes evaluation (ROE) scale were compared. The scores following a normal distribution obtained for each patient were compared using a paired t-test.

Results: Forty-five patients were enroled in this study. Average follow-up duration was 35.4 months. Patients' age ranged from 17 to 57 years. No cases of infection or major graft resorption were observed. No postoperative scars were visible at the donor site. All patients were satisfied after surgery, and a statistically significant difference between pre- and postoperative scores (p<0.0001) was observed.

Conclusion: This study showed that PAFG is a reliable technique for dorsal camouflage and slight augmentation in primary and revision rhinoplasty. The procedure is safe, easy and quick and only requires a small learning curve.

Level Of Evidence Ii: 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).