Fat grafting and tissue transfer during rhinoplasty

Fat grafting and tissue transfer during rhinoplasty

Rhinoplasty is the most common choice for any patient seeking an aesthetic improvement of their nose. In recent years, complementary techniques have been developed to improve the results of rhinoplasty, or even replace it in small cases, one of which is the use of Fat Grafting. The use of Fat Grafting in surgical rhinoplasty allows to smooth irregularities or contour deformities and asymmetries. In addition, several studies have shown that fat grafting has worked as effectively as cartilage grafts or solid implants in surgeries such as augmentation mammoplasty.

A fat graft or lipofilling in the nose can become an excellent ally during the execution of any rhinoplasty and especially during a secondary or revision rhinoplasty. The lipofilling base their versatility on the excellent combination of properties: the possibility of being used as a filler and its capacity to regenerate the tissue where it infiltrates. While fat grafting on the breasts often takes fat from other areas of the body.

Why is skin important during Rhinoplasty?

One of the most important factors that determine the outcome of rhinoplasty is the quality of the soft tissues that cover the bone and cartilage framework of the nose. As in other circumstances of life, also in this aspect, the extremes are not good:

  • Thick skin tends to swell more easily. The possible advantage is that they can cover irregularities or defects that other types of skins would reveal.
  • Thin skin tends to swell less. Its drawback is that any minimal irregularity may be visible. In these types of skin, fat grafts are of great help.

Usefulness in a Primary Rhinoplasty

During a primary Rhinoplasty, the fat grafts will be very useful when it comes to improving the thickness of fine skins, especially on the back. The back of the nose in a patient with thin skin are especially difficult to manage as they reveal even the smallest irregularity. Through a lipofilling, it is possible to soften and slightly thicken that skin so that it acquires a normal thickness. Not only does it hide micro-irregularities, it also facilitates obtaining a uniform nasal dorsum without a “bony” appearance.

In addition, by means of fat grafts, many things can be done during a Primary Rhinoplasty. The grafts of fat allow to improve, if necessary, the angle formed by the nose with the forehead (naso-frontal angle) or the settlement of the wings of the nose (piriformis fossa) to obtain an adequate general contour. The fat grafts can come from performing tumescent liposuction on the body.

Are fat grafts useful during Secondary Rhinoplasty?

One of the most frequent problems after a primary rhinoplasty has to do with the healing processes of rhinoplasty. The nasal skin (especially on the back) can suffer scarring adhesions of different severity, in all its extension or in a localized way. It is not uncommon to see secondary thinning of the nasal skin after rhinoplasty or cartilage grafts. The benefits that we would obtain from a fat graft after a secondary Rhinoplasty would be:

  • A more uniform and smooth appearance.
  • Helps to heal by keeping the adhesions free and facilitating the integration of the grafts.
  • Formation of better structure to the skin.
  • Avoid secondary thinning of the skin that is observed after rhinoplasty.

Fat grafts are somewhat more difficult to perform during secondary rhinoplasty because the anatomical planes are usually altered, fused or have adhesions. For this reason, the rhinoplasty surgeon must have a good knowledge of the nasal anatomy, be familiar with secondary rhinoplasty and correctly master the technique for performing fat grafts.

Are fat grafts useful during Secondary Rhinoplasty?

How fat grafts in the nose behave.

Fat grafts need to survive to be effective, so their collection and placement must be accurate, similar to placing follicles during an FUE hair transplant. If the graft does not survive properly it will slowly disappear and lose its usefulness. If the graft adheres and survives (which is usually the case) it will integrate into its place like a normal tissue without moving. Once the fat adheres, it behaves exactly like any other adipose tissue in the body, so that a conventional posterior rhinoplasty could be performed without any problem.

Problems of fat grafts in rhinoplasty.

Occasionally, the practice of fat grafting is essential to obtain certain results for patients. However, in some cases, problems may arise such as:

  • Loss of the graft and its benefits.
  • Embolization of the arterial nasal network. Embolization of the medullary or dorsal nasal artery can cause immediate pain, blindness or stroke, whereas embolization of the lateral nasal artery in caudal direction can cause soft tissue necrosis to a variable degree
  • Necrosis of the skin.

In summary, although many rhinoplasties and nose jobs can be performed correctly without the need to use fat grafts, however, they are an extremely useful complement during the execution of primary and, especially, secondary rhinoplasties.

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