Safety of Using Tutoplast-Processed Fascia Lata in Rhinoplasty: A Systematic Review and Meta-Analysis

Al-Sebeih KH, Albazee E, Alsakka MA.

PubMed 39948321 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling nine studies covering 827 patients, processed donor fascia lata used in rhinoplasty showed a 2.64 percent shrinkage rate, 0.30 percent infection rate and 3.99 percent revision rate.

Overview

Tutoplast-processed fascia lata is donor connective tissue from the outer thigh, sterilized and preserved, used as a graft to augment or smooth the nasal bridge. The authors evaluated its safety across primary and revision rhinoplasty by searching PubMed, CENTRAL, Scopus, Web of Science and EMBASE, assessing bias with the National Institutes of Health tool for cohort studies and pooling event rates in STATA.

Sections of note

Design: systematic review and meta-analysis. Level of evidence I as assigned by the journal.
Nine studies covering 827 patients were included. Eight had low risk of bias and one moderate.
Graft resorption: 2.64 percent, 95 percent confidence interval 0.69 to 5.62 percent.
Infection: 0.30 percent, confidence interval 0.02 to 0.83 percent.
Dorsal irregularity: 0.96 percent, confidence interval 0.09 to 2.51 percent.
Graft displacement: 0.45 percent, confidence interval 0.07 to 1.12 percent.
Overcorrected dorsal augmentation: 1.29 percent, confidence interval 0.39 to 2.65 percent.
Revision: 3.99 percent, confidence interval 1.82 to 6.90 percent.

What it means for a patient

All six complication types occurred at low rates, with infection under half a percent across 827 patients.
Revision at about 4 percent is the highest of the reported figures, and revision has many causes beyond the graft itself.
Donor fascia avoids harvesting tissue from the patient's own thigh or temple, removing a second incision.
Limits: the pooled studies are cohort studies rather than randomized trials, there is no comparison against the patient's own fascia, and no follow up durations are stated.

Why this paper matters

Camouflaging and augmenting the bridge is one of the most common uses of graft material, and processed donor tissue trades donor site morbidity against uncertainty about how the material behaves. Pooling 827 patients gives the clearest safety picture available. Without a comparison arm, it cannot show donor fascia matches the patient's own.

Terms

Fascia lata: a strong sheet of connective tissue from the outer thigh.
Tutoplast processing: a method of sterilizing and preserving donor tissue for implantation.
Resorption: gradual absorption and loss of graft volume by the body.
Graft displacement: a graft shifting from the position it was placed in.
Dorsal augmentation: adding height to the bridge of the nose.
Event rate: the proportion of patients experiencing a given outcome.

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

Abstract

Objective: To evaluate the safety profile of using tutoplast-processed fascia lata (TPFL) as a graft material in patients undergoing both primary and revision rhinoplasty.

Methods: PubMed, CENTRAL, Scopus, Web of Science, and EMBASE were searched. Eligible studies were evaluated for bias using the National Institutes of Health (NIH) assessment tool for cohort studies. Our safety outcomes included the incidence of graft resorption, infection, graft displacement, dorsal irregularity, overcorrected dorsal augmentation, and revision rates. Data were pooled as event rate (%) with a 95% confidence interval (CI) using STATA software.

Results: Nine studies, comprising 827 patients, were included. Eight studies were evaluated with a low risk of bias, and one study had a moderate risk of bias. The pooled proportion analysis demonstrated a low graft resorption rate (event rate = 2.64%, 95% CI [0.69%, 5.62%]), infection rate (event rate = 0.30%, 95% CI [0.02%, 0.83%]), dorsal irregularity rate (event rate = 0.96%, 95% CI [0.09%, 2.51%]), graft displacement rate (event rate = 0.45%, 95% CI [0.07%, 1.12%]), overcorrected dorsal augmentation rate (event rate = 1.29%, 95% CI [0.39%, 2.65%]), and revision rate (event rate = 3.99%, 95% CI [1.82%, 6.90%]).

Conclusion: This meta-analysis of 827 patients demonstrated that TPFL has a favorable safety profile in both primary and revision rhinoplasty, with low complication and revision rates. TPFL, whether used alone or in combination with cartilage, is a viable graft option for dorsal augmentation and enhancing nasal dorsum contour.

Level Of Evidence I: 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).