What's the different between DCF and solid piece of rib for nasal bridge augmentation?

Question

I am Asian male, with thick skin, very low nasal bridge, I have consulted with several rhinoplasty surgeons, all of them recommend rib harvest to augment my nose, but some recommend using the Diced cartilage fascia (DCF) technique and some recommend using a Solid piece of rib, my goal is to have a higher and natural nose bridge, doesn't have to be too high but defined. What's the different between the two techniques and why? Thank you.

Jacob Sedgh, MD · Answer

DCF is small pieces of cartilage wrapped in a layer of soft tissue covering called "fascia" often harvested from the temple area. The addition of this layer in thin skin individuals can have an extra blanket effect to hide little bumps or stepoffs. When it comes to Asian rhinoplasty the skin is often not thin and the value of a solid piece providing more augmentation outweighs the potential advantage of a DCF in my practice.  Overall a somewhat controversial topic as different practices will have different preferences but if you need major augmentation of the bridge rib is the best choice over other sources of cartilage or silicon.

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well.. based in your question its difficultd evaluted you if the case dont have a picture , its recommended get a consultation with a plastic surgeon to evaluate you.

P. Daniel Ward, MD · Answer

In rhinoplasty, there is often a need to add extra volume to the dorsum or bridge of the nose. Two options that can be used to add this volume are a solid piece of rib cartilage or pieces of cartilage (from the nose, ear, or rib) that are diced into small pieces and then wrapped or covered in fascia. This latter technique is called DCF (Diced Cartilage wrapped in Fascia) and the procedure involves taking cartilage from the nasal septum, the ear, or the rib followed by cutting the cartilage into small pieces. These small pieces are then placed in fascia to help add volume to the nose. The fascia is the lining of muscle and is typically taken from an area on the scalp in the hairline. The fascia helps camouflage the diced pieces of cartilage. 
I prefer to use diced cartilage, because I think that it allows me to create a more natural, smooth nasal dorsum while avoiding the risk of warping, twisting, or uneven edges that can be associated with a solid piece of cartilage.

Toby Mayer, MD · Answer

Rib or diced cartilage/fascia? As you can tell from multiple answers of different techniques each surgeon has his own preference. I haven’t had to use rib to raise a low dorsum over 40 years. Forget the technique and focus on results with Asian noses and major Revision rhinoplasty with low dorsums.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. For dorsal augmentation, I recommend diced cartilage wrapped in fascia (DCF).  DCF does not have the risk of warping over time, which a rib graft has.  Make
sure you specifically look at before and after pictures of real patients
who have had this surgery performed by your surgeon and not just a computer
animation system.  You should be able to
view numerous pictures of actual patients with noses similar to yours performed
by your surgeon.  If you cannot find
enough real before and after pictures, then consider continuing your search for
a surgeon.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Barry L. Eppley, MD, DMD · Answer

Rib grafts are very prone to warping and developing deviations when used as a solid piece. Since most rib sections are curved thus make their shaving into a straight piece during surgery prone to cartilage memory. Dicing or the DCF method completely eliminates that risk by making it many small pieces. However dicing potentially makes the graft have less push on the overlying skin as that of a solid piece. Each method as you can see has their own advantages and disadvantages.

Michael L. Schwartz, MD · Answer

The goal here is augmentation. Using the solid rib provides this but comes with the risk that over time the skin can contract and visible edges may be seen, it is not pliable on facial motion and in some case may shift in position or warp. DCF avoids this by converting the rib into a more pliable and malleable graft that contours well without edge visibility and has proven longevity. The only time solid rib is better is if structural support and replacement is needed in addition to the augmentation.

Johnson C. Lee, MD · Answer

A solid piece of rib cartilage will have increased definition but will have a higher risk of visible warping. DCF can give you an equal amount of height but with less warping risk and slightly less definition due to more rounded edges. Hope this helps!Johnson C. Lee, MD
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Mehdi Sina, MD · Answer

Hi,DCF is diced cartilage wrapped in fascia vs a sold piece of rib. Almost every rhinoplasty expert will recommend diced cartilage because it will contour better and risks of warping are minimized. Best,

Jeffrey T. Steitz, MD · Answer

Thanks for your question!  Rib grafts can be very powerful in Asian rhinoplasty and a variety of techniques are used.  Most surgeons have their own preference towards one or the other but there are a few differences.
Using a solid piece of rib can be one of the most effective means of raising a low dorsum in Asian rhinoplasty.  The graft is carved from a segment of rib cartilage harvested from the chest.  A single segment is then implanted into the bridge after meticulous carving is performed, and fixated either in a tight pocket, with sutures or something called a K-wire.  From the surgeon's perspective this is a nice technique as the graft will not change (resorb) substantially over time, it rarely will move after placement and can be relatively predictable.  On the negative side, rib grafts can warp and if you use a solid piece, it can change shape slightly.  
DCF can also be created from rib cartilage; it is carved into very fine pieces and inserted into a fascial "envelope" which can provide some bulk to the bridge/dorsum.  Many surgeons enjoy this material as it is easily moldable and takes the warping element from a traditional dorsal graft.  Downsides include variable rates of resorption (though minimal) and can have an increased risk of contour irregularities on the bridge.  
Hopefully this answers your question!  Best of luck with proceeding with your rhinoplasty!

What's the different between DCF and solid piece of rib for nasal bridge augmentation?

Answers (11)

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