Clinical utilization of free autologous dermal-fat grafting in rhinoplasty

This study aimed to assess the feasibility and reconstructive efficacy of autologous dermal-fat grafts for dorsal nasal augmentation in rhinoplasty procedures. This study included 26 patients, comprising 20 cases of secondary rhinoplasty revision and 6 cases of primary rhinoplasty. Autologous dermal-fat grafts, approximately 6.0 cm × 1.0 cm × 1.0 cm, were harvested from the gluteal region and used for dorsal nasal augmentation and nasal tip refinement. Among the revision cases, previous procedures included rib cartilage combined with expanded polytetrafluoroethylene (ePTFE) implantation ( n = 6), rib cartilage with silicone ( n = 5), auricular cartilage with silicone ( n = 5), and auricular cartilage with ePTFE ( n = 3). In primary rhinoplasty cases, an umbrella-shaped composite graft of auricular cartilage and dermal-fat tissue was used to contour both the nasal tip and dorsum. In secondary rhinoplasty repair cases, rib cartilage or auricular cartilage was preserved in whole or in part to maintain nasal tip support. An umbrella-shaped dermal graft was placed superficially over the nasal tip cartilage, while a willow leaf–shaped dermal-fat graft was implanted along the nasal dorsum. One patient who initially underwent primary rhinoplasty required secondary dermal-fat grafting because of dissatisfaction with nasal radix height. In all 26 patients undergoing either primary rhinoplasty or secondary revision, dermal-fat composite grafts, alone or combined with auricular cartilage for nasal tip shaping and dorsal augmentation, demonstrated favorable graft survival. All surgical incisions achieved primary intention healing. During a follow-up period of 12 months, adequate nasal tip projection and dorsal height were maintained, with a soft texture and a natural nasal contour. One primary‑rhinoplasty patient underwent secondary supplementary dermal‑fat grafting for insufficient nasal radix height and achieved satisfactory contour after revision. The use of autologous dermal-fat grafts, either as standalone material or in combination with auricular cartilage, in both primary rhinoplasty and secondary revision procedures produces reliable reconstructive outcomes. This approach yields a natural postoperative appearance, supporting its potential for broader clinical application in rhinoplasty.