APS Aesthetic Plastic Surgery · 2026

Fish-Scale Grafts in Rhinoplasty: Ultra-thin, Ultra-viable

Ozturk S, Yazar M, Sevim KZ, Kabukcuoglu F, Ozdemir E.

PubMed 42557455 Publisher (DOI)Free full text (PMC)

What this paper says

In 10 rabbits, ultra-thin "fish-scale" cartilage slices cut with a new M-Slicer device gained the most weight and showed the highest cell survival and proliferation at eight weeks, while diced cartilage wrapped in fascia lost the most volume.

Overview

Cartilage grafts survive by diffusion, and processing methods such as crushing or dicing damage cells. The Turkish authors harvested ear cartilage from 10 rabbits and prepared five graft types: solid block, ultra-thin fish-scale slices, crushed, diced, and diced wrapped in fascia. All were implanted in standardised dorsal pockets and examined at eight weeks by weight and histology (H and E, Masson's trichrome, toluidine blue).

Sections of note

Significant differences among groups in weight change, proliferation and survival (p < 0.01).
Fish-scale grafts: highest median weight gain, greatest chondrocyte proliferation and viability versus crushed, diced and fascia-wrapped diced.
Histology showed preserved architecture and increased peripheral chondrocyte proliferation in fish-scale grafts.
Fascia-wrapped diced cartilage had the greatest volume loss and lowest survival.
Level of Evidence II (as assigned; animal study).

What it means for a patient

Thin slices of cartilage may survive better than chopped cartilage because more of each piece is close to nourishing tissue.
This is a rabbit study over eight weeks; it does not show human results.
If confirmed, the technique could reduce graft shrinkage and irregularity.

Why this paper matters

It challenges the popular diced-cartilage-in-fascia method on biological grounds. Limits: animal model, short follow-up, a proprietary slicing device.

Terms

Chondrocyte: a cartilage cell.
Diffusion: the way nutrients reach cartilage, which has no blood vessels.
Diced cartilage in fascia (DCF): chopped cartilage wrapped in a fascia sheath.
Histopathology: microscopic tissue examination.
Subfascial pocket: a space created beneath the fascia layer for graft placement.

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

Abstract

Background: Achieving long-term structural support and smooth contouring in rhinoplasty remains challenging due to the limited regenerative capacity of cartilage and the destructive nature of commonly used graft-processing techniques. This experimental study aimed to evaluate the viability, proliferation, and survival of a novel ultra-thin "fish-scale" cartilage graft technique compared with conventional cartilage processing methods.

Methods: Ten male New Zealand rabbits were used as an experimental model. Auricular cartilage grafts were harvested and divided into five groups: solid-block cartilage, ultra-thinned fish-scale cartilage prepared using a newly designed M-Slicer device, crushed cartilage, diced cartilage, and diced cartilage wrapped in fascia. All grafts were implanted into standardized dorsal subfascial pockets. After eight weeks, grafts were harvested for macroscopic evaluation, weight analysis, and histopathological examination using hematoxylin and eosin, Masson's trichrome, and toluidine blue staining. Statistical analyses were performed using nonparametric tests.

Results: Significant differences were observed among groups regarding graft weight change, proliferation, and survival rates (p<0.01). The fish-scale cartilage group demonstrated the highest median weight gain and showed significantly greater chondrocyte proliferation and viability compared with crushed, diced, and fascia-wrapped diced cartilage grafts. Histopathological analysis revealed preserved cartilage architecture and increased peripheral chondrocyte proliferation in the fish-scale group. Fascia-wrapped diced cartilage exhibited the greatest volume loss and lowest survival rates.

Conclusion: Fish-scale cartilage grafts produced with minimal chondrocytic damage maximize surface area for diffusion and demonstrate superior survival and proliferation compared with traditional cartilage processing techniques. This method may offer a reliable alternative for camouflage and augmentation in rhinoplasty, potentially reducing resorption, irregularities, and revision rates.

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).