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Overzealous reduction during rhinoplasty may result in manifold functional as well as aesthetic injuries to the nose and is a prevailing antecedent of revision rhinoplasty. Although challenges for the revision rhinoplasty surgeon abound, careful assessment of the anatomic deficiencies of the nose, accurate evaluation and management of a patient's expectations, and precise planning and execution of surgical technique serve to facilitate a successful result. Contemporary techniques for correction of the over-resected nose are discussed, with special attention directed toward costal cartilage grafting and diced cartilage fascia techniques.

ZusammenfassungEine ebenmäßig und ästhetisch modellierte Oberfläche des Nasenrückens und der Nasenspitze ist das erwünschte Endergebnis septorhinoplastischer Eingriffe sowohl für den Operateur als auch für den Patienten. Beim Einsatz von DC im Rahmen der Septorhinoplastik und in den Variationen des DCF (Diced Cartilage Framework) werden bevorzugt autologe Materialien mit hoher Biokompatibilität und damit minimiertem Risiko für Infektionen und Abstoßung verwendet. Histologische Untersuchungen postulieren für den DC und das DCF ein regeneratives Potenzial mit Zugaben von PRF (Platelet rich Fibrin) aus dem eigenen Plasma des Patienten. Die Herstellung des DC und des DCF aus autologem Knorpel ist leicht zu erlernen und kann von der Operationsassistenz parallel zum Eingriff vorbereitet werden. Die Zubereitung des PRF ist standardisiert. Form und Größe der Diced-Cartilage-Grafts sind sehr variabel, ebenso wie der Ort der Applikation an der Nase. Der geschnittene Knorpel kann frei unter die Haut appliziert werden oder als DCF mit autologer Faszie, Perichondrium und aPRF (Advanced Platelet rich Fibrin) Clot umhüllt werden. Der DCF-Graft kann einige Tage nach dem Einsetzen noch nachmodelliert werden. Es sollte keine Überkorrektur erfolgen, denn der Graft verbleibt in der Masse konstant und wird nicht resorbiert. DC und DCF-Grafts sind nicht strukturverbessernd und nur zur Modellierung der Kontur geeignet, sie können als ergänzende Komponente nach einem strukturverbessernden Aufbau der inneren Stützstrukturen der Nase eingesetzt werden. Die Anpassung und Anwendung des DC und des DCF erfolgt somit immer zum Ende der septorhinoplastischen Operation. Die einfache Anwendung und die Flexibilität dieser Technik mit dem Ziel eines modellierbaren, sich schnell in die Kontur des Nasenrückens integrierenden Graft überzeugen sowohl bei FDC (freiem DC) als auch beim DCF. Sie können zur routinemäßigen Anwendung für die Modellierung der Kontur bei einer Septorhinoplastik empfohlen werden.

Background Cartilage grafts are generally accepted for the restoration and reconstruction of nasal contours. The main concern that plastic surgeons may need to address after surgery pertains to the resorption and disfigurement of the grafted cartilage, especially in allogenic and heterogenic grafts. Methods A total of 12 white rabbits were divided into three groups according to the types of graft including autograft, allograft, and heterograft. We used three shapes of grafts, including block, crushed, and diced cartilage in the upper, middle, and lower rows. However, in each rabbit, these grafts were divided into two columns of wrapped and unwrapped grafts, with human amniotic membrane (HAM) grafted on each side of the rabbit's back. Results In total, 60 specimens underwent histopathological examination. No inflammation was observed in about 50% of the block-shaped conchal cartilages with HAM, and in 50%, less than 25 inflammatory cells per unit were seen. The prognosis and absorption of autograft specimens in block-shaped cartilages with HAM were significantly better compared with other shapes of cartilages with HAM and without HAM. The proliferation rate of fibroblasts in autograft and allograft specimens was more than that in heterograft specimens with HAM. Conclusion Our findings have demonstrated the new role of HAM in clinical applications, indicating that HAM may be used as a low-cost, easily accessible alternative for wrapping in cartilage grafts instead of fascia or surgicel in early future. It is useful for improving the long-term outcomes and decreasing the resorption rate.

Author(s): Liao, Junlin; Chen, Yong; Chen, Jia; He, Bin; Qian, Li; Xu, Jiaqin; Wang, Aijun; Li, Qingfeng; Xie, Hongju; Zhou, Jianda | Abstract: ObjectiveTo reconstruct the auricle using a porous, hollow, three-dimensional (3D)-printed mold and autologous diced cartilage mixed with platelet-rich plasma (PRP).MethodsMaterialise Magics v20.03 was used to design a 3D, porous, hollow auricle mold. Ten molds were printed by selective laser sintering with polyamide. Cartilage grafts were harvested from one ear of a New Zealand rabbit, and PRP was prepared using 10 mL of auricular blood from the same animal. Ear cartilage was diced into 0.5- to 2.0-mm pieces, weighed, mixed with PRP, and then placed inside the hollow mold. Composite grafts were then implanted into the backs of respective rabbits (n = 10) for 4 months. The shape and composition of the diced cartilage were assessed histologically, and biomechanical testing was used to determine stiffness.ResultsThe 3D-printed auricle molds were 0.6-mm thick and showed connectivity between the internal and external surfaces, with round pores of 0.1 to 0.3 cm. After 4 months, the diced cartilage pieces had fused into an auricular shape with high fidelity to the anthropotomy. The weight of the diced cartilage was 5.157 ± 0.230 g (P g 0.05, compared with preoperative). Histological staining showed high chondrocyte viability and the production of collagen II, glycosaminoglycans, and other cartilaginous matrix components. In unrestricted compression tests, auricle stiffness was 0.158 ± 0.187 N/mm, similar to that in humans.ConclusionAuricle grafts were constructed successfully through packing a 3D-printed, porous, hollow auricle mold with diced cartilage mixed with PRP. The auricle cartilage contained viable chondrocytes, appropriate extracellular matrix components, and good mechanical properties.Levels of evidenceNA. Laryngoscope, 129:2467-2474, 2019.

The reconstruction of the nasal dorsum after a hump resection is challenging if narrowing of the nose is to be avoided, the nasal skin is very thin, and the nasal bones are short. This report describes the replacement of the bony and cartilaginous nasal dorsum after resection with an anatomically shaped dorsal replacement graft of diced cartilage in fibrin glue. The technique is illustrated with a clinical case and sonographic morphometry of the nasal dorsum and tip. A modification of the diced cartilage glue graft for thin-skinned patients is presented.

Background Different autologous materials are recently used in the purpose of augmentation of the nasal dorsum. Despite the benefits and drawbacks, nasal reconstruction with autologous tissue remains a better method for excellent results and lower morbidity rates. Methods The authors harvested conchal cartilage from the ears and use it after dicing. The superficial temporal fascia was harvested from the temporal region. Diced cartilage was wrapped with superficial temporal fascia, making a roll. After creating a cavity in the nasal dorsum, the combined roll graft was inserted over the nasal dorsum in a "caterpillar" fashion. The authors have operated on 18 patients of secondary nasal deformity cases. Results The results were excellent in most of the cases. This procedure presented many advantages: optimum nasal contouring, satisfactory volume for the nasal dorsum, and with low rates of infection and exposure. Conclusions Nasal deformities were reconstructed using crushed cartilage harvested from the concha and enclosed in temporal fascia. This procedure could provide more psychologic comfort and long-lasting appearance.

Objective: Cartilage grafts are widely used in reconstructing nasal deformity for structural and aesthetic purposes. Despite being immunologically privileged, cartilage grafts are susceptible to volume loss with high risk of resorption over time. Therefore, experts opt for cartilage handling modification to resolve this issue through graft dicing, wrapping, or perichondrium preservation. This study will evaluate the effect cartilage graft preparations on graft viability. Design: Single-randomized post-test-only study design. Setting: Animal Hospital at Bogor Agricultural Institute. Participants: Six New Zealand, male, Hycole rabbits. Intervention: Conchal cartilage grafts were retrieved from 6 experimental rabbits and distributed into 3 treatment groups: diced cartilage graft (DC; control), one-sided perichondrium-attached scored cartilage (OPSC), and tube-shaped perichondrium-wrapped diced cartilage (TPDC). Main Outcome Measures: Macroscopic (weight and contour) and microscopic (chondroblast proliferation, graft thickness, apoptotic cells) evaluation through histological measures were recorded on week 12. Statistical analysis was done to compare between groups. Results: Diced cartilage and OPSC groups showed significant weight changes on week 12 ( P < .05) with OPSC presenting with the biggest difference. Diced cartilage and OPSC group showed moderate cell proliferation on week 12 while TPDC displayed most abundant apoptotic cells (5.8%; P < .05). Diced cartilage group had the highest cartilage thickness ratio ( P < .05). Discussion: Bare DC technique promoted graft thickness while perichondrium-attached scored cartilage showed the most abundant chondroblast proliferation and the least apoptotic cells. Perichondrium contributes to enhanced new cartilage formation. Conclusion: Diced cartilage graft is suitable for masking irregularity and volume augmentation, while perichondrium-attached cartilage graft is better for structural support in nasal reconstruction.

Background Free diced cartilage smaller than 0.2 mm in diameter to smoothen the nasal dorsum is a well-known procedure. However, creating smaller diced cartilage takes a really long time. In contrast, the free diced cartilage technique has some visibility problems, especially in thin-skin patients, although a fine job is done to chop the cartilage. The author aimed to present the "ultra diced cartilage graft" and the way to achieve it, to eliminate the problems of diced cartilage during rhinoplasty, and compare it with free diced cartilage grafting technique. Methods Between April of 2015 and December of 2018, the ultra diced cartilage graft technique in 104 patients and the free diced cartilage graft technique in 113 patients were used to smoothen the dorsum or augment the radix/dorsum. Operation records, rhinoplasty outcome evaluation questionnaire, palpation test, and evaluation of the immediate postoperative photographs on the table with postoperative 1-year postoperative photographs by two independent blinded plastic surgeons were analyzed. Results Ultra diced cartilage seemed superior to free diced cartilage grafting with regard to graft visibility and resorption. Conclusions Ultra diced cartilage graft is an effective and easily reproducible technique in rhinoplasty. There is no extra cost, and it is the easiest and fastest way to have this perfectly pliable cartilage have no dead space. The ultra diced cartilage grafting technique should be known by all plastic surgeons to achieve fineness in rhinoplasty. Clinical question/level of evidence Therapeutic, III.

Rhinoplasty is a thinking-, seeing-, and feeling-person operation. The art of rhinoplasty involves the ability to visualize the outcome of surgery intraoperatively, before the swelling resolves. Surgeons must therefore be able to see with their hands, feel with their eyes, and use their minds to integrate the two.

Many sections of the previous two chapters describe indispensable or frequent surgical steps, whereas many of the next sections of this chapter are therefore dedicated to those particular situations, sometimes infrequent in daily practice, but which the nasal surgeon has to face.

Background Rhinoplasty is considered one of the most challenging operations in the plastic surgery. Esthetic or functional reshaping purposes of the nose can be stressing for both surgeon and patient. Different types of graft materials have been used to perform augmentation rhinoplasty. Free diced cartilage (FDC) was recently established in dorsal nasal rhinoplasty for better handling of irregularities as well as contour deficits of dorsal nasal outcomes. The main purpose of the present study is to assess the effectiveness of the use of FDC in dorsal nasal and nasal tip rhinoplasty and evaluation of its advantages and disadvantages using the validated Nasal Obstruction Symptom Evaluation (NOSE) scale and the Rhinoplasty Outcome Evaluation (ROE) questionnaire to assess nasal obstruction and patient satisfaction. Results This prospective study was conducted between March 2018 and December 2019, 20 patients were included and planned for rhinoplasty using FDC to camouflage dorsal and nasal tip deformities. All patients (11males and 9 females) underwent open rhinoplasty through inverted v columellar incision, taken FDC from nasal septum. A statistical significant difference between pre- and post-operative NOSE scores was found (P Conclusion It was found that the FDC technique is an effective method for camouflage and augmentation of nasal dorsum as well as nasal tip in reconstructive and esthetic rhinosurgery for either primary or secondary rhinoplasty.

Supplemental Digital Content is available in the text., Background: Rhinoplasty is one of the most challenging procedures in plastic surgery because the surgical modifications should attend to patient expectations and to the need for functional correction allied to aesthetics. Composed of leukocytes and platelet-rich fibrin, an autologous membrane has great potential for tissue repair. The purpose of this study was to assess the use of this membrane (associated or not associated with diced cartilage) as an alternative to techniques such as the camouflage and filling; correction of irregularities of the dorsum, nose tip, soft triangle, and K zone; filling in of dead space; skin camouflage; and an improvement in the healing process in primary or secondary rhinoplasties. Methods: The membranes were obtained by centrifuging patients’ peripheral blood before the rhinoplasty. At the time of use, the membrane was removed from the tube, separated from the clot, and used in the camouflage and filling process in patients operated on due to various indications: 19 associated with diced cartilage, and 4 sole. The authors present the clinical and photographic impressions of the immediate and late postoperative period, as well as the patients’ opinions using a specific questionnaire. Results: No patient had immediate or late postoperative complications. The use of leukocyte- and platelet-rich fibrin (L-PRF) was sufficient to carry out the camouflage and filling in all patients, and the patient declared satisfaction. Conclusions: This membrane was shown to be an excellent surgical alternative to the camouflage and filling in rhinoplasty. In addition, it is rich in factors that can improve and accelerate regeneration of tissues.

Importance: Diced cartilage (DC) is a reported technique that has been used for dorsal camouflage after reduction rhinoplasty. Nevertheless, there are certain issues regarding its use on nasal dors...

Background: In the context of different grafts being used for dorsal augmentation, diced cartilage with glue has gained worldwide acceptance. Aims: To develop a system of tools to objectively evaluate the desired dimensions of the required graft for dorsal augmentation and to prepare a corresponding customized-glued-diced cartilage construct. Materials and Methods: A modification of the diced cartilage glue technique called Autogenous control augmentation system (ACAS) was used in ten patients. Results: Of the ten patients, in which this technique was used, eight underwent primary rhinoplasties and two underwent secondary rhinoplasties between July 2017 and December 2017 with a follow-up ranging from 3 to 8 months. In all the cases, the dorsum is straight, and height is maintained. Conclusion: The technique has all the advantages of the diced cartilage glue. The shape resembles alloplastic implant with height and width varying from radix to tip. There is tapering of the cephalic and caudal ends for more natural results. The brow tip aesthetic lines are better defined. The limitation of this study is short follow up.

Empty nose syndrome (ENS) is a rare entity in patients who undergo sinonasal surgery due to over-resection of the turbinate. This syndrome leads to debilitating symptoms that include dry nose, painful nasal breathing, paradoxical nasal obstruction, crusting, and sleep disorder. The goal of surgical treatment is to reestablish the volume of the turbinates to rehabilitate the nasal resistance. Endonasal microplasty with cartilage implants on the lateral wall of the nasal cavity is useful for creating the neoturbinate. Here, we present 2 cases that describe the management of empty nose syndrome by endonasal microplasty using platelet-rich fibrin (PRF) scaffolds embedded with a diced cartilage graft. The integration of the PRF scaffolds with diced cartilage efficiently facilitated the reestablishment of the neoturbinate. This autologous biomaterial is suitable for the treatment of ENS.

Background Asian cleft rhinoplasty is a unique procedure with specific challenges. Objectives This paper presents our experience with the use of an open structural technique for Asian cleft rhinoplasty utilizing a complete autologous approach. Methods An open approach that reconstructs the malpositioned nasal cartilage was utilized. Centrally, the septocolumella graft fixed securely in the midline with extender spreader grafts was utilized to project and lengthen the nose. The dislocated lateral crura on the cleft side was completely detached from the accessory cartilages and mobilized off the vestibular lining. The deficient medial crura was lengthened with the lateral crural steal procedure. The resultant shortened lateral crura was then reconstructed with the lateral crural strut graft (LCSG). This gave the versatility needed to bring the tip cartilages into a more anatomic and symmetrical position. Tip suturing and grafting was performed and dorsal augmentation achieved through diced cartilage wrapped in deep temporal fascia. At closure, when indicated, a modified Tajima reverse-U excision of the vestibular lining was performed to correct the alar hooding on the cleft side. Alar base modifications were done as indicated. Results From January 2010 to December 2015, 35 Asian patients underwent open cleft rhinoplasty. There were 18 female patients and 17 male patients. Twenty-nine patients were unilateral cleft and 6 were bilateral cleft. The mean follow up was 23 months. All patients were highly satisfied with the functional and aesthetic improvement of the procedure. The complications and revision rates were low. Conclusions The autologous open structural approach can predictably and consistently give excellent results for Asian cleft rhinoplasty. The result attainable is superior to results attainable before adopting this approach for our patients. Level of evidence 4.

Background There are instances where small or large pockets are filled with diced cartilage in the nose, without use of wrapping materials. For this purpose, 1-cc commercial syringes were used. The obtained results were partial and incomplete. For better and improved results, the author designed new syringes, with two different sizes, which compress the diced cartilage for injection. Methods The author presents his experience accrued over the past 12 years with 2366 primary, 749 secondary, 67 cleft lip and nose, and a total of 3182 rhinoplasties, using his new syringe design, which compresses diced cartilage and injects the diced cartilages as a conglutinate mass, simulating carved costal cartilage, but a malleable one. Results In 3125 patients, the take of cartilage graft was complete (98.2 percent) and a smooth surface was obtained, giving them a natural appearance. In 21 patients (0.65 percent), there was partial resorption of cartilage. Correction was performed with touch-up surgery by reinjection of a small amount of diced cartilage. In 36 patients (1.13 percent), there was overcorrection that, 1 year later, was treated by simple rasping. Conclusions Compared with diced cartilage wrapped with Surgicel or fascia, the amount of injected cartilage graft is predictable because it consists purely of cartilage. The injected diced cartilage, because it is compressed and becomes a conglutinated mass, resembles a wood chip and simulates carved cartilage. It is superior to carved cartilage in that it is moldable, time saving, and gives a good result with no late show or warping. The injection takes only a few minutes.

The objective of this study was to investigate the viability and biomechanics of diced cartilage blended with platelet-rich plasma (PRP) and wrapped with poly (lactic-co-glycolic) acid (PLGA) membrane in a rabbit model.A total of 10 New Zealand rabbits were used for the study. Cartilage grafts were harvested from 1 side ear. The grafts were divided into 3 groups for comparison: bare diced cartilage, diced cartilage wrapped with PLGA membrane, and diced cartilage blended with PRP and wrapped with PLGA membrane. Platelet-rich plasma was prepared using 8 mL of auricular blood. Three subcutaneous pockets were made in the backs of the rabbits, and the grafts were placed in these pockets. The subcutaneous implant tests were conducted for safety assessment of the PLGA membrane in vivo. All of the rabbits were sacrificed at the end of 3 months, and the specimens were collected. The sections were stained with hematoxylin and eosin, toluidin blue, and collagen II immunohistochemical. Simultaneously, biomechanical properties of grafts were assessed.This sample of PLGA membrane was conformed to the current standard of biological evaluation of medical devices. Moderate resorption was seen at the end of 3 months in the gross assessment in diced cartilage wrapped with PLGA membrane, while diced cartilage blended with PRP had no apparent resorption macroscopically and favorable viability in vivo after 3 months, and the histological parameters supported this. Stress-strain curves for the compression test indicated that the modulus of elasticity of bare diced cartilage was 7.65 ± 0.59 MPa; diced cartilage wrapped with PLGA membrane was 5.98 ± 0.45 MPa; and diced cartilage blended with PRP and wrapped with PLGA membrane was 7.48 ± 0.55 MPa, respectively.Diced cartilage wrapped with PLGA membrane had moderate resorption macroscopically after 3 months. However, blending with PRP has beneficial effects in improving the viability of diced cartilages. Additionally, the compression modulus of diced cartilage blended with PRP and wrapped with PLGA membrane was similar to bare diced cartilage.

OBJECTIVE To assess the viability and biomechanics of bare diced cartilage grafts. METHODS Cartilage samples were collected from 1 ear in 15 rabbits as well as costal cartilage. Each rabbit was inserted bare diced- and single-strip costal-cartilage grafts, respectively, into paraspinal subcutaneous pockets: after euthanasia at 2 months, specimens were weighed, with diced cartilage grafts examined histomorphologically by hematoxylin-eosin staining, masson trichrome staining, and immunohistochemistry. Finally, biomechanical properties of grafts were assessed. RESULTS Bare diced cartilage grafts were connected into an integrated mass after 2 months, and inward growth of fibrous tissues and angiogenesis were observed. Mean wet weights of diced cartilage grafts were 1.603 ± 0.278 and 1.662 ± 0.204 g pre- and postoperation, respectively; those of costal cartilage grafts were 0.053 ± 0.008 and 0.058 ± 0.008 g, respectively. In compression assays, mean modulus values of elasticity at yield in diced- and costal-cartilage grafts were 7.65 ± 0.59 and 22.30 ± 1.15 MPa, respectively (P

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.

Diced cartilage is a significant alternative approach to cartilage grafting. However, the viability and biomechanical properties of diced cartilage grafts remain to be improved, and the role of perichondrium is largely neglected. This study aimed to evaluate the histological and biomechanical effects of perichondrium on custom-shaped diced cartilage grafts constructed via a high-density porous polyethylene mold. Seven New Zealand rabbits were used. Unilateral auricular cartilage was harvested and divided into 2 parts, with or without perichondrium, diced into 1 × 1 × 0.5 mm cubical pieces, and filled into high-density porous polyethylene molds. Three grafts with the perichondrium removed and 3 with the perichondrium preserved were implanted subcutaneously at the dorsum. The grafts underwent biomechanical and histological tests 4, 8, and 12 weeks after the implantation. The diced cartilage merged into integrated blocks without observable resorption in both groups at each time point. Additionally, the retention rate of weight was higher in the perichondrium-preserved group (P

The comparison of patient satisfaction with the use of diced cartilage graft wrapped in fascia (DCF) graft in composite versus dorsum augmentation-only reconstructions (DAOR), technical hints and complications in our series, affecting the end-result and the patient satisfaction (PS) has been presented.Between 2013 and 2018 the DC-F graft is used in 32 rhinoplasty cases. Nine of patients have had composite reconstruction (CR). The DAOR has been needed for 23 of patients.The follow-up period has been 2 months to 3 years. The authors have obtained satisfactory results in 24 cases but some untoward progress in 8 cases. A questionnaire was prepared and asked all patients for the assessment of the satisfaction from appearance, breathing, self-esteem, and positive psychological effect.The learning curve for rhinoplasty should be calculated for, hump reduction, crooked nose, augmentation rhinoplasty, and so on. separately which is also relevant for the use of a DC-F graft. Placing the DC-F over a straight platform, choosing the accurate graft and fascia material wisely, proper tailoring of DC-F, sliding it under the skin-superficial musculoaponeurotic system properly etc. determine the quality of the end result and the degree of PS. Operating on the DAOR are relatively more comfortable compared to CRs but responses to our questionnaire denote higher degrees of satisfaction in CR cases.Utilization of the DC-F graft in secondary rhinoplasties for dorsum augmentation provides satisfactory results. The degree of PS with the DC-F reconstruction seems to have an adverse correlation with the extent of deformities that you start with.

Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. Fourteen patients with minor contour deformity were treated with fluid cartilage filler gently injected as autologous fluid graft in deep planes of defect of the nose that were close to the bone or the cartilage. A computerized tomographic scan control was performed after 12 months. Pearson&rsquo, s Chi-square test was used to investigate differences in cartilage density between native and newly formed cartilages. The endpoints were the possibility of using fluid cartilage as filler with aesthetic and functional improvement and versatility. Patients were followed up for two years. The constructs of fluid cartilage graft that were injected in the deep plane resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation. This report demonstrated that fluid cartilage grafts are useful for cartilage regeneration in patients with outcomes of rhinoplasty, internal nasal valve collapse, and minor congenital nose aesthetics deformity.

Supplemental Digital Content is available in the text., Summary: Free diced cartilage graft represents a relatively innovative technique with multiple applications. It is conventionally used for smoothening, augmentation, or camouflaging of the nasal dorsum in primary or revision rhinoplasties. The aim of the article was to give some tips and tricks about harvesting and preparation of free diced cartilage to maximize its exploitation and make it easily repeatable, extending the field of application not only to the nasal dorsum but also other sites, such as the tip of the nose.

EgeUn###, Diced cartilage is one of the most widely used camouflage technique in rhinoplasty. Its variable resorption rate creates issues in postoperative time period. Platelet-rich fibrin is an autologous concentrated blood derivative containing growth factors that accelerate tissue healing. The authors evaluate the effect of injectable platelet-rich fibrin (I-PRF) on the viability of diced cartilage, which has been used for dorsum camouflage in rhinoplasty. Forty patients were randomly divided into two groups based on dorsal camouflage grafts: diced cartilage with I-PRF (study group) and diced cartilage without I-PRF (control group). Cartilage graft thickness was measured by linear superficial tissue ultrasound at the postoperative first week and the third month in both groups. The mean cartilage graft thickness loss between the first-week and third-month ultrasound measurements was 0.58 +/- 0.21mm in the study group and 0.82 +/- 0.35mm in the control group. There was significant volume loss in the control group. I-PRF was successful in reducing the resorption rate of diced cartilage on nasal dorsum by either increasing the viability or keeping its form. Sticky cartilage is an easily applicable and reliable technique that may be used to camouflage dorsal irregularities in rhinoplasty., European Acad Facial Plast Surg

Introduction: Rhinoplasty constitutes an example wherein the various types of filling materials are used for nasal dorsal deformities. In this study, we took the advantage of a simplified procedure and used fibrin isolated from the coagulated peripheral blood of the experimental animal. Durability and viability of diced autologous cartilage grafts adhered to each other and formed using fibrin extracts were assessed experimentally in a rabbit model. Subjects and Methods: Diced cartilage graft (Group 1), block cartilage (Group 2), and fibrin adhered 0.5 mm diced cartilage graft (Group 3) were placed into subcutaneous pockets in the frontoparietal region of the same experimental animal. The grafts were excised at the end of 16 weeks. The excised grafts were macroscopically evaluated, and the final volumes and weights were measured. These measurements were compared to the initial values before implantation. Finally, the specimens were evaluated the histopathological examination. Results: In Group 1, 165% increase in weight and 56% increase in volume; in Group 2, 131% increase in weight and 81% increase in volume; finally in Group 3, 184% increase in weight and 68% increase in volume were seen. Although histological examination did not reveal any difference with regard to chondroid matrix score, metachromasia, vascularization, fibrosis, and inflammation we observed significantly higher cartilage proliferation score in Group 3. Conclusion: The results indicate that these grafts can be used efficiently, particularly in rhinoplasty procedures to correct nasal deformities.