What is soft tissue onlay in rhinoplasty?

Hi and thank you for your question.  Board certified facial plastic surgeons will use a technique called soft tissue on-lay during rhinoplasty to fill indentations or provide a smooth final contour line once the patient has fully healed.  The soft tissue used can consist of perichondrium (tissue which covers cartilage), fat or fascia (tissue which covers muscle) depending on your doctor’s specific preferences and your specific needs.  Your local, board-certified facial plastic surgeon can advise whether soft tissue on-lay, cartilage grafting or a combination of both techniques will best achieve the results you desire.  I hope this information helps.  Good luck with your procedure!
- Jacqueline T. Cheng, MD

  This term refers to adding a small graft of tissue to the nose where there is a depression in the nose during a rhinoplasty procedure.  The tissue could be dermis or morcellized cartilage.

Soft tissue is sometimes used to cover the bridge or tip of the nose in patients with thin skin. Temporalis fascia or alloderm are most commonly used for this purpose. This provides a thin soft tissue cover in order to help give a smooth appearance to the bridge of the nose.

Soft tissue is material that is very soft and is placed in the nose to cover any depressions, irregularities etc. Typical material can be fascia, mucoperichondrium. 
Regards
Dr. Janjua

Hello and thank you for your question. It depends on what part of rhinoplasty you are refrring to.  For dorsal augmentation, soft tissue onlay can refer to fascial graft, sometimes wrapped around diced cartilage.  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. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Generally speaking, a soft tissue onlay is a free piece of tissue which can be a soft piece of cartilage, fat, fascia (connective tissue), or other tissue which can be laid down in an area to provide volume, or to camouflage, or soften the contour of underlying structures.  I believe that this is what you are referring to in your question.  

There are 2 main indications in temporalis fascia grafting:-skinny noses with transparent skin in which any dorsum maneuver leads to visible irregularity, requiring camouflage-dorsal irregularities non treatable with other methodsMany surgeons advocate the use of deep temporal fascia, I rather prefer the superficial one since it is richer in collagen and incorporates underneath a millefeuille tissue multilayer making it ideal to fill the gaps and smoothen the nose; the superficial temporalis fascia is literally like photoshopping the nose with a filter.See below cases in which I could use this technique.

This is when a tissue graft is used to place under the nose skin to raise a depressed area.  The tissue graft can come from the patient, or from a cadaver donor.  You should speak with your own surgeon about their preferences and their rationale for the choice.

Good question. Most rhinoplasty questions and answers in this space refer to firm structural grafts usually of cartilage.  Rhinoplasty healing over the long term creates a "shrink wrap" effect of the skin on the nasal skeleton sometimes causing irregularities or sharp edges to appear years later. In patients with thin skin or who have had previous procedures with scarring and poor blood supply it is sometimes helpful to cover the bony cartilage structure with a soft cushioning layer such as fascia (the sheath that covers your muscles) or perichondrium. This acts as a lining to prevent irregularities from showing and also gives subtle augmentation. In some cases these grafts are combined with cartilage to achieve both effects.

This often refers rot cartilage grafting +/- fascial wrap for coverage on the dorsum of the nose to provide more soft tissue coverage.