Autologous Fascial Grafting for Alar Base Depression: A Novel Technique in Asian Rhinoplasty

Zhao H, Wang X, Yang K, Qiao Z, Yi K, Ju Y, Zeng W, Hsiung N, Zou P, Ye J.

PubMed 41813990 Publisher (DOI)Free full text (PMC)

What this paper says

In 52 Asian patients, placing the patient's own fascia at the sunken area beside the nostrils reduced measured alar base depression from a grayscale value of 0.720 to 0.583 with no graft displacement or foreign-body complaints.

Overview

A sunken area at the base of the nostrils (paranasal depression) is common in patients with a retruded midface. The authors reviewed 52 patients who had fascia grafting at the alar base during open rhinoplasty. Fascia came from behind the ear or from the rectus abdominis, depending on where cartilage was also harvested. Depression was measured by grayscale image analysis in ImageJ, and satisfaction by a modified ROE scale.

Sections of note

52 patients, retrospective review.
Grayscale value fell from 0.720 to 0.583 (P < 0.05), indicating less shadowing at the alar base.
Alar width and base width changes were minimal and not significant.
Mean ROE score rose notably; no foreign-body sensation or graft displacement was reported.
Any change in tip projection or nasolabial angle is described as an indirect effect, not a target of the fascia graft.

What it means for a patient

Hollowing beside the nostrils can be filled with the patient's own tissue rather than filler or implant.
In this series the graft did not widen the nostrils and did not shift.
Fascia harvest adds a donor site (behind the ear or abdomen), though the authors paired it with cartilage harvest already planned.

Why this paper matters

It describes an autologous solution for a midface contour problem that is otherwise treated with synthetic paranasal implants in Asian rhinoplasty. Limits: retrospective, single centre, no comparison group, follow-up not stated in the abstract.

Terms

Alar base: where the nostril meets the cheek.
Paranasal depression: hollowing of the cheek beside the nose.
Fascia: the tough fibrous sheet covering muscle, usable as a soft graft.
Grayscale analysis: measuring shadow darkness in a photograph as a proxy for depth.
Midfacial retrusion: a flat or set-back middle face.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Nasal base depression is a frequent aesthetic concern in rhinoplasty, particularly in patients with midfacial retrusion. This study introduces a fascia transplantation technique to correct alar base (paranasal) depression and restore nasal-facial harmony through structural support of the alar base.

Methods: A retrospective analysis was conducted on 52 patients who underwent fascia grafting during open rhinoplasty. Fascia placement was performed primarily for alar base/paranasal augmentation; changes in tip projection or nasolabial angle, when present, were not direct surgical targets of the fascia graft. Fascia was harvested from postauricular or rectus abdominis regions, depending on the cartilage source. Nasal morphology was evaluated pre- and postoperatively using standardized anthropometric measurements. Alar base depression was quantitatively assessed through grayscale image analysis using ImageJ. Patient satisfaction was measured with a modified Rhinoplasty Outcome Evaluation (ROE) scale. Complications were monitored via clinical examination, standardized photography, and a structured questionnaire addressing symptoms such as foreign-body sensation, graft displacement, and local discomfort.

Results: Following fascia-based nasal base augmentation, significant aesthetic improvements were observed. Alar width and base width changes were minimal and statistically insignificant. Postoperative grayscale analysis showed a significant decrease in values (from 0.720 to 0.583, P < 0.05), indicating reduced alar base depression following fascia grafting. The mean postoperative ROE score increased notably, with no major complications such as foreign-body sensation or graft displacement reported.

Conclusion: Fascia transplantation provides stable augmentation of the alar base/paranasal region with a favorable safety profile; any observed changes in tip projection or nasolabial angle should be interpreted as secondary (indirect) effects rather than direct targets of fascia placement. It represents a safe and effective autologous option for achieving durable, harmonious aesthetic outcomes in rhinoplasty.

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).