Dorsal Nasal Augmentation: Is the Composite Graft Consisting of Conchal Cartilage and Retroauricular Fascia an Effective Option?

Purpose: Augmentation of a deficient nasal dorsum remains a challenge in rhinoplasty. Different methods and materials have been described in the literature. The purpose of this study was to present the authors' experiences using a composite graft consisting of conchal cartilage and retroauricular fascia for dorsal augmentation. Materials and Methods: Patients with moderate to severe dorsal deficiencies were included in this study. The postauricular sulcus was used to gain access to the auricular cartilage and the retroauricular fascia. If the dorsal deficiency was moderate, then 1 layer of conchal cartilage was used. In more severe deficiencies, the cartilage pieces were superimposed, and a multilayer conchal graft was used. To fix the cartilage segments to each other, 6-0 polydioxanone (PDS) suture was used. Then, the cartilage segment was fixed to the retroauricular fascia with 6-0 PDS suture. The nasal dorsum was undermined carefully to create adequate space for chondrofascial graft placement. After performing required maneuvers for solving the functional disorders, tip plasty, and the lateral nasal wall osteotomy, the prepared chondrofascial graft was placed in the dorsal pocket. Results: Fourteen patients (5 men and 9 women) participated in this study. The average follow-up duration was 25.4 months (range, 16 to 42 months). The patients' age ranged from 14 to 54 years (average, 25.9 yr). Follow-up showed no cases of infection, hematoma, major graft resorption, asymmetric graft resorption, and displacement of grafts. No postoperative scars were visible at the donor sites. Mild to moderate ecchymosis occurred at the donor sites in 8 patients, which were solved after 10 days without any complications. In 3 male patients, slight graft resorption was noted. The esthetic results were not compromised in these patients, and revision surgery was not performed. Conclusion: This small series of cases with relatively adequate follow-up showed that a composite graft consisting of conchal cartilage and retroauricular fascia is a reliable technique for nasal dorsal augmentation in patients with moderate to severe dorsal deficiency. (C) 2015 American Association of Oral and Maxillofacial Surgeons