Template for Diced Cartilage with Platelet-Rich Fibrin (PRF) in Rhinoplasty: An Easy Solution for Millimetric Camouflage of the Full Dorsal Esthetic Unit

Abstract

Dorsal irregularities are one of the most common issues in modern rhinoplasty. Rhinoplasty surgeons propose placing interface grafts lining the hole dorsum to ensure a natural unoperated look. Diced cartilage embedded in Choukroun's platelet-rich fibrin (PRF) scaffold being one of the most recent innovations in the field. However, no method has been described to help with the creation of thin, malleable, and reproductive graft with millimetric precision using that technique. The senior author details his protocol and his experience with a newly developed template for the creation of reproductive grafts with standard size and thickness, using diced cartilage, injectable PRF (iPRF), and advanced PRF (aPRF), for full dorsal camouflage and lining in rhinoplasty. This retrospective case series was conducted to evaluate the results looking at the dorsal esthetic unit at a minimum of 6 months for patients who beneficiated from a millimetric dorsal augmentation from 1 to 2mm using diced cartilage with iPRF and aPRF. The author reports his experience with 54 cases operated from April 2018 to May 2022 using his newly developed template.The template is an innovative technique to allow faster and more reliable fabrication of soft grafts using diced cartilage with both iPRF and aPRF. This novel approach allows for millimetric dorsal augmentation from 1 to 2mm with great precision and high reproductivity with good esthetic outcome.

Keywords

rhinoplasty - dorsum - PRF - template - reconstruction

Publication History

Accepted Manuscript online:
25 January 2023

Article published online:
14 March 2023

• Reference

• 1 Zholtikov V, Golovatinskii V, Ouerghi R, Daniel RK. Rhinoplasty: aesthetic augmentation with improvement of dorsal aesthetic lines. Aesthet Surg J 2021; 41 (07) 759-769
• 2 Daniel RK. Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg 2008; 122 (06) 1883-1891
• 3 Kreutzer C, Hoehne J, Gubisch W, Rezaeian F, Haack S. Free diced cartilage: a new application of diced cartilage grafts in primary and secondary rhinoplasty. Plast Reconstr Surg 2017; 140 (03) 461-470
• 4 Yoo SH, Kim DH, Jang YJ. Dorsal augmentation using a glued diced cartilage graft fashioned with a newly developed mold in Asian rhinoplasty. Plast Reconstr Surg 2022; 150 (04) 757e-766e
• 5 Kovacevic M, Riedel F, Wurm J, Bran GM. Cartilage scales embedded in fibrin gel. Facial Plast Surg 2017; 33 (02) 225-232
• 6 Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J. Platelet-rich fibrin and soft tissue wound healing: a systematic review. Tissue Eng Part B Rev 2017; 23 (01) 83-99
• 7 Choukroun J, Adda F, Schoeffler C, Vervelle A. Une opportunité en paro-implantologie: le PRF. Implantodontie 2000; 42: 55-62
• 8 Dohan DM, Choukroun J, Diss A. et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101 (03) e37-e44
• 9 Whelihan MF, Kiankhooy A, Brummel-Ziedins KE. Thrombin generation and fibrin clot formation under hypothermic conditions: an in vitro evaluation of tissue factor initiated whole blood coagulation. J Crit Care 2014; 29 (01) 24-30
• 10 Gode S, Ozturk A, Kısmalı E, Berber V, Turhal G. The effect of platelet-rich fibrin on nasal skin thickness in rhinoplasty. Facial Plast Surg 2019; 35 (04) 400-403
• 11 Gode S, Ozturk A, Berber V, Kısmalı E. Effect of injectable platelet-rich fibrin on diced cartilage's viability in rhinoplasty. Facial Plast Surg 2019; 35 (04) 393-396
• 12 Sclafani AP, Saman M. Platelet-rich fibrin matrix for facial plastic surgery. Facial Plast Surg Clin North Am 2012; 20 (02) 177-186 , vi