APS Aesthetic Plastic Surgery · 2025

Wound Healing in External Rhinoplasty-The Effect of Fibrin Glue on Dead Space Closure: A Retrospective Propensity Score-Matched Study

Mortier J, Bilotta G, Fransen E, Pingnet L, Verkest V, Declau F.

PubMed 39638903 Publisher (DOI)Free full text (PMC)

What this paper says

Comparing 66 patients whose nasal skin was glued to the framework with fibrin glue against 66 matched patients without it, no difference in appearance outcomes was found over 12 months.

Overview

Dead space under lifted nasal skin allows erratic soft tissue contraction, and poor redraping of the skin over the framework leaves that space behind. Fibrin glue, a biological adhesive made from clotting proteins, has reduced adverse events in other areas of plastic surgery. The authors tested whether it improves long term healing in open septorhinoplasty using propensity score matching to create comparable groups.

Sections of note

Design: retrospective propensity score matched analysis. Level of evidence III.
154 patients were enrolled; after matching, two equal groups of 66 were retained.
The first group had rhinoplasty without fibrin glue; the second had human fibrin glue applied to improve skin adherence to the framework.
Assessment used the FACE-Q nose and nostrils scales, the Utrecht Questionnaire with a visual analog score, and the NOSE scale, before surgery and at 3, 6 and 12 months afterward.
All patients improved highly significantly on all patient reported measures, and results remained stable across time points.
No statistically significant difference in aesthetic outcome was found between the glue and no glue groups.

What it means for a patient

Fibrin glue made no measurable difference to how satisfied patients were with their appearance at any point up to a year.
Both groups improved substantially, so the operation worked; the question was whether the glue added anything, and it did not.
The authors continue to state that closing dead space matters, but this particular method did not demonstrate a benefit.
Limits: retrospective, matching cannot remove all differences the way randomization would, and outcomes were measured by questionnaire rather than by imaging of the space itself.

Why this paper matters

Negative findings are rare in rhinoplasty literature, and a well matched study showing an adjunct does not help is useful precisely because it discourages an added cost and step. Dead space management remains a stated priority. Which method actually reduces it measurably is still unresolved.

Terms

Fibrin glue: a biological adhesive made from blood clotting proteins.
Dead space: an empty pocket under lifted tissue where fluid can collect.
Redraping: how the skin settles back onto a reshaped framework.
Osseocartilaginous framework: the combined bone and cartilage structure of the nose.
Propensity score matching: pairing patients across groups on background characteristics to reduce bias.
Patient-reported outcome measure: a questionnaire completed by the patient rather than the surgeon.

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

Abstract

Introduction: The presence of "dead space" in external rhinoplasty creates a welcoming environment for erratic soft tissue contraction. Poor redraping of the skin over the underlying osseocartilaginous framework at the end of the surgery may result in its creation. If surgeons can control and reliably predict skin contraction and wound healing, septorhinoplasty results would undoubtedly improve. Fibrin glue application has previously demonstrated a reduction in adverse events in plastic surgery. Several potential advantages have been attributed to the application of fibrin glue, such as reducing downtime, improving patient satisfaction and reducing complication rates.

Objective: To evaluate the effectiveness of homologous fibrin glue on the long-term healing process in external rhinoplasty.

Material And Methods: We performed a retrospective propensity score-matched analysis in 154 patients enrolled for external septorhinoplasty. An aesthetic evaluation was performed with the FACE-Q nose and nostrils, the Utrecht Questionnaire including VAS score and the NOSE. Assessments were conducted prior to surgery and post-operatively at 3, 6 and 12 months. After propensity score matching, two equal groups of 66 patients were retained. The first cohort of 66 patients underwent a rhinoplasty without the application of fibrin glue; in the second cohort of 66 patients, human fibrin glue was used to achieve better adherence of the skin to the underlying skeletal framework.

Results: All patients had a statistically highly significant improvement on all PROMs post-operatively. The post-operative results remained stable over the different time points. However, no statistically significant difference in the aesthetic outcome was discovered whether fibrin glue was used or not during surgery.

Conclusions: Obliteration of dead space is a key component in septorhinoplasty as it minimizes soft tissue contraction, resulting in a more predictable outcome. Although fibrin glue has been used successfully in different medical fields, no long-term positive effects on patient satisfaction could be detected in the present study.

Level Of Evidence Iii: 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).