Is deep temporal fascia a good augmenting material for increasing tip projection and lengthening columella?

You’ve got a big question that requires much more information to answer. In general, plastic surgeons replace like with like. This means cartilage gets replaced w cartilage, bone w bone, skin w skin.Use of DTF is commonly used to augment soft tissue, not cartilage, unless used with diced cartilage, mostly for the dorsum rather than the tip, or columella. Having no septal cartilage left, choices for tip and columellar augmentation become rib cartilage, rib bone, or off the shelf materials like medpore, ptfe, pds plate, etc, depending on the exact need. There’s a difference between resorption and incorporation... resorption means it goes away, incorporation means the body grows into itvand it remains. DTF should incorporate. Using it for support isn’t among my favorite ideas, but its excellent for camouflage under thin skin, but not to support the tip or tip structures. Without pictures, specifics about your case like how many prior surgeries, I would be cautious about giving you direct answers about results. If you can give us more info, or schedule a consult here at WAVE Plastic Surgery if you are in the Southern California Location or San Francisco.

Deep temporal fascia is useful to build the bridge and cover up any irregularities.  It will not lengthen the nose or improve tip projection.

Deep temporal fascia is certainly a good graft material to use in rhinoplasty where indicated. It will not provide the stabilty of cartilage where it is necessary. To comment on wether it would be appropriate for correction of your particular nasal deformities would require an examination. I am assuming that you are having revisional surgery and that you septum has previously used for graft material. In my practice ,I would typically approach revisional surgery of this complexity through an open approach.

Hello,Increasing nasal projection is challenging and requires the use of strong materials.  People who need projection usually have naturally soft "squishy" tip cartilage.  Stacking more soft material (like DTF) over the tip of this weak structure just squeezes down those weak underlying tissues instead of adding projection or length.  I use structural cartilage grafts that reinforce the natural tip cartilages allowing for additional cartilage grafts to then be placed over the top of the now structurally supported base for added projection or length.  Temporal fascia just doesn't work well at all for adding projection, it works best for "packaging" other grafts like diced cartilage dorsal grafts or for covering irregularities in thin skinned people.  In the case of a saddle nose, perhaps temporal fascia used to contain a diced cartilage onlay graft may be appropriate.  It just depends on the severity of the saddle and the stability of the cartilage framework in that area.  My preference in a saddle nose, however, is to fashion a single solid piece of cartilage to fill the defect.Dr. A  

No, deep temporal fashion is only used as a camouflage when patients have thin skin. It is used  to hide the irregularities of the nasal tip cartilages so that they do not show through very thin skin in the nasal tip. It will not lengthen the projection of the nose or the columella.