Department of Plastic Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA.
Aesthet Surg J. 2022 Aug 1;42(8):874-887. doi: 10.1093/asj/sjac030.
Dorsal augmentation is one of the most challenging procedures in rhinoplasty. Solid grafts and diced fascia graft (DC-F) have been employed for this purpose with varying success. Warping, irregularities, and variability of final height are some of the potential pitfalls.
The aim of this study was to assess the efficiency of the authors' approach combining multiple grafts for nasal dorsal augmentation. They described a technique employing composite dorsal augmentation that is a combination of a foundation layer utilizing high spreader grafts plus a dorsal gap graft combined with a contour layer of 3 possible types of fascia or DC-F grafts. The combination of the 2 layers for the nasal dorsum can be varied to achieve the required height to correct the patient's deformity and achieve the desired aesthetic goals.
Fifty-one patients who underwent dorsal augmentation with composite technique between 2017 and 2020 were retrospectively reviewed. A step-by-step algorithm was applied to achieve the required dorsal height.
The patients were divided into 3 groups according to the type of contour graft: double-layer fascia graft, segmental DC-F, or narrow thin full-length DC-F. Smooth continuity and increased projection of the nasal dorsum were achieved in all patients.
Composite dorsal augmentation is an effective technique for dorsal augmentations requiring 4 mm or more of height increase. This technique allows to achieve dorsal augmentation employing a combination of grafts from a single donor site together with camouflaging dorsal irregularities and highlighting dorsal aesthetic lines. This algorithm allows optimization of patients' aesthetic profile.
鼻背增高是鼻整形术中最具挑战性的手术之一。为达到这一目的，曾使用过固体移植物和切碎的筋膜移植物（DC-F），但效果不一。潜在的问题包括变形、不平整和最终高度的可变性。
本研究旨在评估作者采用多种移植物联合进行鼻背增高的方法的效果。他们描述了一种技术，采用复合式鼻背增高，该技术结合了使用高展筋膜移植物的基础层，加上一个背侧间隙移植物，并结合 3 种可能类型的筋膜或 DC-F 移植物的轮廓层。背侧 2 层的组合可以根据需要进行调整，以达到矫正患者畸形和实现所需美学目标所需的高度。
回顾性分析了 2017 年至 2020 年间采用复合技术进行鼻背增高的 51 例患者。应用逐步算法来达到所需的背侧高度。
根据轮廓移植物的类型，患者被分为 3 组：双层筋膜移植物、分段 DC-F 或窄而薄的全长 DC-F。所有患者的鼻背都实现了平滑的连续性和增加的突出度。
复合式鼻背增高是一种有效的技术，适用于需要增加 4 毫米或更多高度的鼻背增高。这种技术可以采用来自单个供体部位的移植物组合来实现鼻背增高，同时掩盖背侧不规则性并突出背侧美学线。该算法可优化患者的美学轮廓。
