Pros and Cons of Fascia Grafting in Rhinoplasty?

Question

In my recent pre-op visit my surgeon informed me that he will be doing both fascia and ear cartilage grafting to build my bridge. What are the risks and is this normal for my first procedure? Or is this type of grafting usually just used in revision surgery? Will there be a longer healing time associated with these procedures?

Brian Maloney, MD, FACS · Answer

Building up the bridge can be done with several different materials. Implants can consist of, ear cartilage, septal cartilage, rib cartilage, or fascia. Potential complications include infection, hematoma, asymmetry, loss of a portion of the graft, need for another procedure. These materials are commonly used in primary and revision surgery. Healing time is roughly similar for the different materials.

Bora Ok, MD · Answer

Hello from Istanbul, thanks for your question. Using ear or rib cartilage grafts to enhance the bridge's support and definition is a common practice in rhinoplasty. Complementing this, fascia is used as a scaffold, guiding the cartilage grafts to maintain the intended shape. Thanks to its rich blood supply, fascia not only ensures the cartilage's vitality but can also address deficiencies in soft tissue in specific areas. While fascia may sometimes cause increased swelling (edema), these are quite rare, and when they do arise, they generally resolve naturally. Best of luck!

Jonathan Kulbersh, MD · Answer

The potential risks of using cartilage and fascia are as follow:

	1) Asymmetry
	2) Irregularities
	3) Infection

	Keep in mind that the risk of infection is dramatically lower when using your own natural tissue and cartilage compared to using an artificial implant. They are readily accepted by your body, and yield a natural result. It is perfectly normal to use autologous tissue and cartilage for a primary rhinoplasty, they are not just for revisions. The healing time will not be any different. I hope this helps, and I wish you the best of luck with your surgery.

Paul S. Nassif, MD · Answer

Using temporalis fascia is a great option to build the bridge during rhinoplasty, and can yield a fantastic result. Temporalis fascia can be used during primary or revision rhinoplasty. Your initial recovery will be the same following surgery.
	I hope this helps, and I wish you the best of luck.

Ronald J. Edelson, MD · Answer

These are acceptable ways of building up the bridge if that needs to be done. Make sure your surgeon is experienced with rhinoplasty especially ethnic rhino.

Steven Wallach, MD · Answer

It sounds like you are having a "turkish delight' which is diced cartilage with fascia wrapped around it to augment the dorsum. This is sometimes used for primary rhinoplasty.

Andrew S. Frankel, MD · Answer

Fascia is a connective tissue usually harvested from the temple via a small incision in the scalp.There are rarely any problems from this procedure other than some tenderness for a few days. The main reason to employ fascia is to camouflage potential irregularities that might arise from underlying sharp points. Think of it as adding a layer to the skin; sort of like using a down comforter rather than a sheet to lay over the nasal structure. If a patient already has thick skin then there is absolutely no good reason to use fascia as it will only add bulk and create a loss of definition. That layer of fascia holds onto swelling for a long time and can result in a layer of scar tissue which can be both desirable or undesirable depending on the particular issues. Recently surgeons have gone to wrapping small diced pieces of cartilage into fascia (like a burrito) for use as an augmentation onlay graft. While this might be beneficial and indicated in revisions or persons with thin skin, it is unnecessary in cases where a solid cartilage graft can be placed under normal or thicker skin. In the latter cases it simply requires that the surgeon be skilled at carving the dorsal graft and meticulous. It is my opinion that a solid structural graft provides more definition than a wrapped fascia graft.

William Portuese, MD · Answer

Ear cartilage is a second vest type of cartilage used for rhinoplasty and revision rhinoplasty. It is always best to use nasal cartilage for a primary rhinoplasty when cartilage grafting is required. Nasal cartilage is a much better grafting source when required to augment the nose. Fascia is an additional tissue that can be harvested to wrap around the graft to make it feel softer.

Maurice P. Sherman, MD (retired) · Answer

Fascia grafting has been around for years with good, but not long lasting results. A new material, called ADM (acellular dermal matrix) which comes from donor skin, is a sheet of human collagen that can be wrapped around diced cartilage and used to augment the nasal bridge, as well as soften the bony ledges, and has become more useful and predictable. The only negatives are a moderate increased cost factor and a longer post op duration of mild swelling, so that patients need to be patient for several months before realizing their new optimal results.

Talmage J. Raine, MD, FACS (retired) · Answer

In general, fascia and cartilage grafts are perfectly acceptable for augmenting certain aspects of the nose.  There is longer jealing , and prolonged swelling with the graft procedures. The main danger is displacement of the grafts in the healing process.

	Talmage Raine MD FACS

	drraine.com

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