Using Dermofat Grafting in Revision Rhinoplasty.

[BACKGROUND] For revision surgeries due to complications associated with alloplastic materials, autologous tissues including dermofat are considered. However, graft absorption, shaping, and donor site morbidity remain crucial challenges. This study aimed to present several surgical techniques of dermofat grafting for rhinoplasty to overcome these challenges.

[METHODS] Patients who underwent autologous dermofat grafting from January 2015 to October 2019 were retrospectively studied, and those who underwent primary rhinoplasty were excluded. The mid-sacral dermis (with the thickest dermal layer) was selected as the main donor site. During dermal harvesting, fat was resected into a wedge shape, to minimize flap tension and dead space risk. A molding technique was applied to improve graft shape and height and minimize graft absorption. Patient records were reviewed for assessing preoperative evaluations, surgical methods, and complications. For evaluating aesthetic outcomes, three rhinoplasty surgeons, blinded to the study purpose, compared preoperative and postoperative photographs.

[RESULTS] Among 331 cases undergoing dermofat grafting for revision rhinoplasty, 25 underwent revisions; of these, five, one, and nine cases experienced over-absorption, over-correction, and deviation, respectively. One and eight cases underwent revision due to a widening scar at the dermofat donor site and wound dehiscence, respectively. Notably, one case had inflamed sinus formation.

[CONCLUSIONS] The advanced dermofat graft technique provided favorable results with selection of appropriate donor site and a dermofat graft with subdermal fat. The application of this molding technique and proper management of donor site ameliorated critical disadvantages, thereby providing a safe and effective alternative for revision rhinoplasty.

[EBM LEVEL IV] Rhinoplasty.