Temporal Fascia -- Used as blanket cover and potential complications?

Question

Now I've had a horrible primary, where my surgeon literally hacked off my bridge. I am looking into using coastal cartilage for bridge augmentation. Can temporal fascia be used as a blanket to hid graft irregularities? Now would this technically disrupt or limit the bloodflow to the nose and constrict its vascularization? Please I need all the input I can get. Thanks.

Alejandro Nogueira, MD · Answer

At the temple we have 2 temporal fascias:-deep temporal fascia aka temporal muscle fascia: it is a thin and fibrotic gliding surface of tendinous features, slim and hard, very transparent; it is very easy to harvest and takes 10 min to do so, however provides scarce camouflage since it skeletonizes and replicates the underlying irregularities if they are very deep; this one os used by most surgeons, specially those keen on making "turkish delight" or diced cartilage wrapped in fascia (a technique which, IMHO, is awful and unadvisable)-superficial temporal fascia aka temporoparietalis fascia: it is as thin as the deep one and almost as firm but... as precious and valious underlying thick millefeuille multilayer of PURE COLLAGEN which is of paramount importance, since will act as glue, concrete and filler of any tiny gap, edge or irregularity, adapting spontaneously to the contours (obviously these colagenous layers have to face downwards and the gliding smooth fascia outwards, unlike the deep fascia here the positioning counts a lot), gaps, edges, empty corners, etc... there is nothing like this, it is unparalleled by other tissue camouflage options (periostium, perichondrium, etc); this one is used by few surgeons, why? I never knew or understood why, and needless to say is my choice for irreparaible fine dorsal irregularities, hide dorsal onlay grafts, extremely skinny noses (not only at the dorsum, also the sides and tip), or camouflage nasal walls irregularities; it is one of the most awesome and essential tools when you deal with regular revision cases or ethnic noses, I have been using it for decades achieving perfectly neat and smooth nasal contours, invisible dorsal grafting, etcIts use does not (in my wide experience) compromise the vascular take and the survival of dorsal grafting, no one of my cases underwent resorption or suffered early necrosis of fascia or the underlying grafts.

Mark Checcone, MD · Answer

RevisionSeeker23, 
Revision rhinoplasty will frequently utilize costal cartilage, fascia, and other forms of autologous grafting material (meaning from your own body). Autologous material is safe and will not disrupt blood flow. You are correct to consider costal cartilage if there was a large amount resected from the dorsum (nasal bridge). You are doing the right thing to research the revision surgery well before proceeding. 
My preference for autologous tissue that will "blanket cover" irregularities on the dorsum--or to help camouflage dorsal on-lay grafts--is costal perichondrium. This is the soft tissue surrounding your rib cartilage and is widely available when costal cartilage is already being harvested. It is thicker and more abundant than temporal fascia. 
I hope this helps!
Best,

Julie Edween, DO · Answer

RevisionSeeker23,Be sure to consult with a rhinoplasty specialist regarding the options you have to revise your nose.  Without photographs it is difficult to discern if temporalis fascia is the best option to build up your bridge. Temporalis fascia has been used to overlay the underlying bony cartilaginous structure of the nose as a "blanket" to cover minor irregularities, and it also has been successfully used in combination with diced cartilage grafts to augment the bridge of the nose.  Best of luck!

Jarrod Little, MD · Answer

Temporal fascia is sometimes utilized during rhinoplasty procedures to give very subtle augmentation or to camouflage minor irregularities.  It is often used when other graft options are unavailable.  Although temporalis fascia is useful, it can provide a barrier between your skin and a required, underlying cartilage or bone graft.  The issue is controversial, however, a graft that does not have adequate contact to vascularized tissue is at significant risk for resorption.  As always, it is important to personally consult with a board-certified Plastic Surgeon, who specializes in rhinoplasty

Temporal Fascia -- Used as blanket cover and potential complications?

Answers (4)

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