Diced Costal Cartilage Combined With Tissue Adhesive in Rhinoplasty: How I Do It and Why

Abstract Background Predictable dorsal augmentation remains challenging in rhinoplasty, particularly in revision and contracted nose deformities. Solid costal cartilage provides structural support but may be associated with warping, rigidity, and graft visibility, whereas diced cartilage offers greater contour adaptability. Objectives To describe a reproducible technique for dorsal augmentation using diced costal cartilage combined with tissue adhesive and to report clinical outcomes and complications in a large contemporary series. Methods Between 2022 and 2023, rhinoplasty using diced cartilage for dorsal augmentation was performed in 476 patients. Autologous costal cartilage or irradiated homologous costal cartilage (IHCC) was selected based on clinical indication. The technique emphasized meticulous graft preparation, precise pocket dissection, injectable placement, and postoperative external molding. Outcomes were evaluated through photographic documentation, physical examination, and patient feedback. Results Patient age ranged from 19 to 72 years, with more than 80% female patients. Approximately two-thirds were revision cases, and nearly three-fourths were classified as complicated. Among 298 patients with follow-up exceeding 6 months (mean, 10.5 months), no clinical evident graft warping, loss of dorsal height, or graft resorption was observed. Aesthetic outcomes were stable and predictable, with high patient satisfaction. Complications were infrequent and manageable with minimally invasive interventions. Conclusions With appropriate indications and refined technique, diced cartilage provides a versatile and reliable option for dorsal augmentation in both primary and revision rhinoplasty, offering a practical balance between structural support and contour flexibility.