Modern methods for nasal dorsal augmentation in secondary rhinoplasty

Objective. To analyze efficiency and safety of nasal dorsal augmentation techniques in secondary rhinoplasty. Material and methods. We analyzed 102 articles devoted to different methods of dorsal augmentation in secondary rhinoplasty. The PubMed, Google Scholar, Scopus, Cochrane, and RSCI databases were screened using the following keywords: «secondary rhinoplasty», «revision rhinoplasty», «dorsal augmentation costal cartilage», «costal cartilage rhinoplasty», «dorsal augmentation conchal cartilage», «secondary rhinoplasty grafts», «secondary rhinoplasty silicone», «secondary rhinoplasty diced cartilage», «secondary rhinoplasty bone», «rhinoplasty PTFE», «rhinoplasty ADM», «rhinoplasty pHDPE», «rhinoplasty fillers». After reading the abstracts, we reviewed full-text Russian- and English-language articles published until April 2024. Nasal dorsal augmentation with autologous cartilage, autologous and alloplastic grafts was analyzed. When analyzing the articles, we evaluated objective results of dorsal augmentation, intra- and postoperative complications. Results. Nasal dorsum height may be adjusted using various autologous cartilage grafts depending on available septal cartilage after primary surgery, the necessity to restore nasal septal support and necessary dorsal augmentation. These cartilages include septal, costal and auricular ones, as well as combinations with fascial, bone, and diced cartilage. This review also describes dorsal augmentation with the most common alloplastic implants (silicone, expanded polyethylene, high-density polyethylene, and injectable soft tissue fillers). Conclusion. Autologous grafts are optimal for nasal dorsal augmentation due to their biocompatibility and ability to produce natural and long-term results. In redo rhinoplasty, rib cartilage is preferable due to denser nature compared to septal and auricular cartilages. Thus, rib cartilage provides rigid support and resists the forces of scar contracture of skin and soft tissues. Unlike septal and auricular cartilages, rib cartilage provides sufficient quantity not only for septal reconstruction but also for dorsal and radix nasal augmentation. Other biological grafts such as fascia and diced cartilage are successfully used alone for minor dorsal augmentation (<4 mm), or in combination with cartilage autografts.