The Versatile Posterior Auricular Fascia in Secondary Rhinoplasty Procedures

Overview

Revision rhinoplasty often needs added material to build volume and support and to soften the edges of cartilage grafts so they do not show through the skin. Several sources of fascia have been used for this. This article reviews the authors' clinical records for one source, the layer behind the ear, and describes its two main uses.

Sections of note

• The clinical records of patients receiving posterior auricular fascial grafts were reviewed; the abstract gives no patient count.
• Use one: covering the tip reconstruction under thin tip skin, described as a camouflage graft.
• Use two: fill and augmentation, especially of the nasal bridge, and as an interpositional graft between the bridge and the tip.
• The graft is described as generous in quantity and readily harvested at the same time as conchal cartilage.
• Donor site morbidity is described as minimal and the scar is concealed behind the ear.
• Level of evidence V. No outcome measures, complication rates, or follow-up are reported.

What it means for a patient

• Thin nasal skin can show the outline of cartilage grafts, and a fascia layer is used to blur that outline.
• The donor area is behind the ear, which can be harvested in the same sitting as ear cartilage.
• Limits: level V evidence, no patient count, no comparison with other fascia sources, and no reported results or follow-up.

Why this paper matters

Camouflage material is a recurring need in revision surgery, and the choice of donor site affects scarring and operating time. This proposes one convenient source. The abstract offers no data showing it performs better than temporalis or other fascia.

Terms

• Fascia: A thin sheet of fibrous tissue covering muscle or other structures.
• Posterior auricular: Located behind the ear.
• Secondary rhinoplasty: An operation on a nose that has already been operated on.
• Conchal cartilage: Cartilage taken from the bowl of the ear.
• Donor site morbidity: Problems caused at the place the graft was taken from.