Summary: Achieving a stable and well-defined nasal dorsum can be challenging, especially in patients with a thicker soft-tissue envelope that masks underlying graft contours. Although numerous grafting methods—ranging from solid cartilage to diced cartilage wrapped in fascia—have been described, each carries limitations related to donor-site requirements, contour precision, and behavior in patients with heavier skin. This submission presents a different strategy for dorsal augmentation by using the nasal superficial musculoaponeurotic system (SMAS) itself as a vascularized conduit for diced cartilage. The technique involves shaping a pedicled SMAS flap into a tubular construct that holds and delivers diced cartilage along the dorsum. By functioning as an intrinsic wrapper, the flap avoids the need for remote fascia harvest and simultaneously allows controlled thinning of the soft-tissue envelope when indicated. The concept diverges from earlier uses of SMAS in rhinoplasty, which have primarily involved camouflage or resurfacing roles, and from SMAS-based periosteal flaps that serve structural purposes. In contrast, the described construct is designed specifically to house diced cartilage, offering a biologically active container that may enhance long-term stability and dorsal smoothness. Early clinical application suggests improved definition and contour regularity, particularly in patients in whom traditional methods struggle to overcome soft-tissue bulk. Additional evaluation will clarify the technique’s reproducibility and its potential role as an alternative in dorsal augmentation.
Sami et al. (2026) studied this question.