Abstract
Costal cartilage grafting is increasing in popularity with increased demand for augmentation
rhinoplasty and increased need for grafting material for structure rhinoplasty techniques.
Use of costal cartilage for dorsal grafting is both art and science. The art is demonstrated
in the act of carving a dorsal graft that will reflect the actual contour of the nasal
dorsum. The science is linked to the methodology of how the grafts are contoured to
match the patient's desires and how the graft is fixed to the bony dorsum to minimize
the risk of warping and displacement. Variations in dorsal graft design and methods
of fixation are described. Use of the perichondrial interface between dorsal graft
and perforated/rasped nasal dorsum acts to ossify the dorsal graft to the underlying
bone, creating an immobile and natural appearing nasal dorsum. The fixation of the
dorsal graft limits movement and hence decreases the likelihood of warping or deformity.
Use of microfat in rhinoplasty has tremendous potential for camouflage and to promote
healing of compromised tissues. Using microfat-infused soft tissue augmentation (MISTA),
the surgeon is able to deliver microfat to an open surgical field, promote healing,
and provide soft tissue augmentation. In this technique, microfat is injected into
soft tissue carriers (perichondrium, temporalis fascia, etc.) and then implanted into
the surgical field. MISTA has tremendous potential utility in many areas of cosmetic
and reconstructive surgery.
Keywords costal cartilage - dorsal augmentation - Asian rhinoplasty - rib cartilage - microfat
in rhinoplasty - microfat-infused soft tissue augmentation
