In general, I have found that either temporalis or dermal grafts do very well here.
During the course of a typical rhinoplasty, it is fairly simple to gather some soft tissue from the fascia along the sidewall and transplant this. If a large volume is required, I tend to prefer either temporalis fascia or a dermal graft such as Alloderm.
The longevity in the tip area is quite good. Most experienced rhinoplasty surgeons will frequently lay a thin layer of fascia over this area to soften the tip structures and avoid any visible irregularities from cartilage grafts or suture refinement techniques.
This is a great question. So temporalis fascia can be a very good graft to use in the nose for various reasons. To use it to thicken the skin, maybe. Better said it would add some volume to the area that may give you better soft tissue coverage between the cartilage and bone of the nose and the skin. It can partially resorb over time but usually it gets it's blood supply form the surrounding tissues and then it should be there forever. I would really have to see you and discuss this to be able to know more of what your goals are.
Temporalis fascia is an excellent material that can be used to cover cartilage grafts or to add some bulk in noses with a thin soft tissue envelope. The fascia is revascularized like a skin graft and once it is revascularized it should last forever since it your own tissue. This is essentially no different than a skin graft that would be used for a burn patient. The recovery should be no different than a standard rhinoplasty except for the healing of the donor site in the scalp.
Fascia, dermal matrix, and fat grafting are all viable options to add some distance between the cartilage and the surface of the skin. The decision depends on the specifics of your nose. Fat grafting can be a low down time, softer alternative but of course this depends on each patient and each plastic surgeon.
All the best,
Dr. Remus Repta
Temporal fascia is a very useful graft for increasing the thickness of the soft tissues during rhinoplasty. In patients with thin skin, it can be used to help camouflage irregularities of the bone/cartilage framework. It provides subtle volume augmentation when used and can also be combined with cartilage, in particular diced cartilage (diced cartilage-fascia), for even greater volume augmentation. Temporal fascia being your own tissue and also being thin, typically revascularizes well in the nose and should be very stable longterm.
Great question. Temporalis is probably the best option for thickening your skin because it tends to have a very smooth and natural contour when the edema has resolved, and it's very safe. Implants and injectables are more likely to have infectious complications and even contour irregularities. Cartilage grafts are also effective but are better for structure and are more likely to be visible through thin skin. I think temporalis fascia is probably your best option.
I would need to know why you believe the skin needs to be thickened. It is much more common for the opposite problem to exist, that is, skin on the nasal tip that is too thick.using a fascia graft on the tip could make the tip look fat, and I can't imagine the situation where it would be worthwhile. Some surgeons use it on the bridge to camouflage imperfections, but I have never found it necessary.