Do you have advice for irregularity following diced cartilage with fascia graft? (Photo)

Question

After many operations, and after diced cartilage with fascia for dorsal augmentation, still I have irregularity due to very very very thin skin, please your advice as am too frustrated

Howard Webster, MBBS (Hons), FRACS · Answer

HI there.Thanks for your question.I've seen some answers so far here that are good, some more risky, and I would certainly advise you not to have an permanent filler injection such as silicon. That could, if it got infected, be disastrous to your nose.Here's my approach:If you're happy with the straightness and smoothness of your nasal bones and cartilage under the skin, then the challenge is to thicken the skin or the subcutaneous layer underneath the skin. If the skeleton is not straight and smooth, then that is the problem, not the skin.Assuming the skeleton is smooth, I think you can readily be treated with a non surgical approach. The most effective method is to use hyaluronic acid filler. Its density, or viscosity, can actually fill or disguise irregularity effectively. Tethered skin points can be released via a subcision technique. It's temporary and needs to be repeated, but is also reversible if there is a problem. That's very good. A single treatment if effective, lasts for years - at least 2, maybe more.Nanofat graft is an option. It needs to be explained to you though that a single treatment will not correct the problem. Fat injected is soft, thin and has no viscosity. Irregularity would persist. With several (2 - 4) grafts, I would expect a smoother and thicker skin, and I think it would work. IT is the most natural and healthy approach for the skin, and once working well should give you a long term improvement. But it would take some time to get there.These two options are simple and can be done under local anaesthetic walk in walk out, with minimal recovery.All the best.Howard WebsterPlastic Surgeon.

Zoran Potparic, MD · Answer

For correction of this type of irregularities one could consider a thin cadaver dermal graft (Alloderm) or your own fascia to correct deformity. Filler may be a solution as well as fat grafting. In person evaluation would help. Good luck..

John Michael Thomassen, MD · Answer

I would recommend nano fat grafting to this area to correct the irregularities.  This may need to be repeated but it should build up a smooth dorsum.

Raghu Athre, MD · Answer

The first question I would have for you is how long after surgery are you experiencing this issue.  I would wait 12 mos post surgery to ensure all swelling etc has resolved.If this is the case, you have many options.1.  Micro droplet silicone grafting2.  Autologous fat micrografting3.  Fascia grafting4. Micro-diced cartilage/PRP carrier grafting

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