Refining the Nasal Dorsum with Free Diced Cartilage

Abstract

Refining the nasal dorsum has become a major challenge in modern rhinoplasty as irregularities of the nasal dorsum account for a significant number of revision surgeries. In our department, free diced cartilage is now routinely applied for smoothening of the nasal dorsum. In this retrospective study, the outcomes with regard to irregularities or contour deficits of the nasal dorsum of 431 rhinoplasty cases operated by a single surgeon between July 2013 and June 2015, using free diced cartilage, are compared with 327 cases operated by the same surgeon between January 2007 and December 2008, before the introduction of the free diced cartilage technique. A decrease in early revision surgeries (i.e., revision within the 2-year period evaluated) due to dorsal irregularities or contour deficits is seen. Being a quick, easy, and highly cost-effective procedure, we feel that free diced cartilage is currently the ideal technique for refinements of the nasal dorsum.

Free Diced Cartilage: Tips and Tricks of a Customized Procedure in Rhinoplasty

“…In accordance with Hoehne et al, 2 harvesting particles whose diameter is less than 0.2 mm means that cartilaginous nutrition is facilitated, as the surface area is significantly enlarged and the diffusion distance reduced compared with larger diced or even solid cartilage grafts. As a result, cartilage viability is extremely likely, as demonstrated by their findings.…”

“…In fact, a fine-particle cartilage paste (particle diameter less than 0.2 mm) is realized and directly put into the desired location with a Freer elevator or, more commonly, a previously holed 1-ml syringe. 1,2 The syringe is drilled first to allow any excess fluid to be squeezed out and inject “pure” FDC through an unilateral gap infracartilaginous incision. The FDC is finally molded into the desired shape and fixed with drapes.…”

“…Furthermore, 24-gauge is a suitable size for a needle meant to drill the syringe surface, as mentioned by the authors. 1,2 In fact, a wider caliber would allow the small cartilage particles to get out of the syringe; a smaller one would be ineffective. However, as it is not a very resistant needle, it may be necessary to replace it during the procedure: its tip is likely to get blunted or bended.…”

“…The authors 1,2 suggested the insertion through the infracartilaginous incision before skin closure in the open approach. However, we would like to emphasize the extreme versatility of this method, which is also applicable in case of closed approach, by placing the FDC on site through the intercartilaginous incision.…”

“…Furthermore, the same authors 1,2 focused on the dorsal placement of the cartilage paste. Anyway, we also found applicability of FDC for a better definition of tip projection, fullness, and blunt profile.…”