Meeting abstract
Rhinoplasty revision with dorsal augmentation by using PRF and temporalis fascia: case report
Mateo Čukman
; KBC Sestre milosrdnice, Zagreb, Hrvatska
Ivan Rašić
; KBC Sestre milosrdnice, Zagreb, Hrvatska
Abstract
Background: Platelet rich fibrin (PRF) provides better healing, hemostasis, less pronounced edema and lesser
resorption of the autologous augmentation material. The aim of this case report is to present a patient
undergoing the 2nd revision rhinoplasty, after unsatisfactory results regarding function and esthetics. Case
report: A middle-aged women, who had previously undergone rhinoplasties on two occasions in an external
institution, presented with nasal dorsum irregularities, lower nasion, rocker deformity, bilateral internal and
external valve insufficiency and acute nasolabial angle. The functional problem was solved by using bilateral
spreader grafts and lateral crural strut grafts shaped by previously harvested septal cartilage. The reinforced
lateral crura were separated from the hinge area and placed in the previously dissected alar rim pockets. The
ptotic tip was reinforced by using an ANSA banner graft. The desired tip width, rotation and tip defining point
position was achieved by domal creation sutures, interdomal sutures and tip position suture. Since the patient
had an extremely thin skin, no tip refinement graft was used. Dorsal irregularities were to be addressed by
using minor hump removal, fine drilling of residual irregularities with a diamond burr and camouflage on lay
graft composed of previously harvested temporalis fascia with platelet rich fibrin matrix placed between the
fascia and skin-soft tissue envelope. The patient has undergone regular follow ups since, reporting an improved
function as well as a satisfactory esthetic result. Physical examination has shown normal nasal patency,
uninterrupted brow tip line with smooth contours of the dorsum and normal nasolabial angle. Discussion: By
reviewing the literature, most authors recommend PRF application as an addition to the diced cartilage
camouflage graft for dorsal irregularities, showing superiority compared to the temporalis fascia, in terms of
better healing, lesser edema, lesser resorption and smoother contours. In our case we decided to use temporalis
fascia and PRF only, since the patient had an extremely thin skin, numerous minor irregularities and a lack of
septal cartilage left for harvesting. It has provided a satisfactory result both subjectively and objectively upon
follow up examinations by the surgeon.
Keywords
revision rhinoplasty; platelet rich fibrin; dorsal augmentation; temporalis fascia
Hrčak ID:
308043
URI
Publication date:
19.9.2023.
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