Stratified dorsal augmentation - A novel technique for dorsal reconstruction.

[INTRODUCTION] Dorsal augmentation enhances nasal dorsum height and contour. Existing techniques face challenges like resorption, infection, and migration. This study introduces Stratified Dorsal Augmentation, a multi-layered cartilage grafting approach to improve stability and aesthetics.

[METHODS] A total of 68 patients (19 males, 49 females) underwent open structural rhinoplasty (2020-2023). Autologous costal cartilage was harvested (7th rib in females, 8th in males) using U-shape technique. Grafting involved: (1) diced cartilage for surface smoothing, (2) a solid 2 mm obliquely split costal cartilage graft for structure, (3) an additional diced cartilage layer for contouring, and (4) a perichondrium overlay for stability. The average follow-up was 29 months.

[RESULTS] All patients achieved the desired dorsum height. No cases of graft rejection, migration, or warping occurred. Two vestibular infections resolved with antibiotics, and two minor bleeding cases were managed conservatively. Three patients required minor secondary revisions.

[CONCLUSION] The Stratified Dorsal Augmentation technique minimizes warping, migration, and resorption, while ensuring both long-term stability and a natural appearance, making it a safe and effective alternative for dorsal augmentation.

[LEVEL OF EVIDENCE] IV.