The Fibrin Wrap Graft: Dorsal Augmentation Rhinoplasty Using Dice Cartilage Graft Wrapped with Plasma-Rich Fibrin Sheet

Dorsal nasal augmentation rhinoplasty is a considerable challenge, not only because of the type of surgery but because it is performed in revisional or secondary surgeries with fibrosis in most cases. In many others, the augmentation is made in noses with structural damage of the upper lateral cartilages and framework over resection of the nasal septum, where restructuring often is insufficient in structure and support. Nevertheless, the fined diced cartilage graft plays an essential role in regularizing the nasal dorsum, increasing its volume and projection, and improving the aesthetic lines of the nose and the tip-to-dorsum relationship. Dorsal nasal augmentation can be done using the open or closed approach. However, the closed approach in rhinoplasty generates a different dare due to decreased tissue visualization and approximation. Still, it also has an advantage: it can objectively assess the different nasal relationships in real-time. This article intends to show a novel technique using multiple thin sheets of plasm-rich fibrin (PRF) wrapping fined diced cartilage as an alternative to the different methods currently available for nasal dorsal augmentation in primary and secondary rhinoplasty, with some potential advantages such as complete biointegration because of the autologous tissue and the intrinsic growth factors in the PRF, precise contouring, low complication rate, great enlargement of the dorsum, easily malleable intraoperatively and first eight days postoperative. These potential advantages have been preliminarily assessed; however, they require prospective studies and comparison with other techniques to assess them objectively. Keywords : Dorsal augmentation rhinoplasty, Fined diced cartilage graft, Plasma-rich fibrin, Platelet-rich fibrin, Platelet-rich plasma.