Free Diced Cartilage: A new application of diced cartilage grafts in primary and secondary Rhinoplasty.

Background: Irregularities or deformities of the nasal dorsum after hump reduction account for a significant number of revision rhinoplasties. We therefore developed a technique of meticulously dicing and exactly placing free diced cartilage grafts (fDC), harvested from septum, rib, or ear cartilage. The cartilage paste is used for smoothening, augmentation, or camouflaging of the nasal dorsum in primary or revision rhinoplasties. Methods: A retrospective analysis of multi-surgeon consecutive open approach rhinoplasties from January to December 2014 was conducted at a single center. We compared the outcome of three different techniques to augment or cover the nasal dorsum after an observation period of seven months: In Group I, 325 patients with fDC as the only onlay were included. In Group II, consisting of 73 patients, the dorsal onlay was either fascia alone, or in combination with fDC. 48 patients in Group III received a dorsal augmentation with the 'classical' diced cartilage in fascia (DCF) technique. Results: 446 patients with primary and secondary rhinoplasties in which one of the above-mentioned diced cartilage techniques was used were included in the study. We found revision rates for dorsal irregularities within the seven-month postoperative observation period of 5.2%, 8.2%, and 25% for Groups I-III, respectively. Conclusion: Our findings strongly support our clinical experience that the fDC technique presents an effective and easily reproducible method for camouflage and augmentation in aesthetic and reconstructive rhinosurgery. (C)2017American Society of Plastic Surgeons

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