Rhinoplasty and the nasal SMAS augmentation graft: advantages and indications.

We evaluated the nasal superficial musculoaponeurotic system (SMAS) as an autologous augmentation graft material in the thick-skinned patient undergoing cosmetic rhinoplasty using a retrospective review. Representative case reports demonstrated preliminary long-term results after augmentation with the nasal SMAS graft in an academic rhinoplasty practice. En bloc excision of the nasal SMAS in thick-skinned patients produced uniformly favorable improvements in nasal tip definition without adverse sequelae. Moreover, in 10 patients, the harvested material was also used for volume augmentation at various adjacent nasal sites, including the radix, nasal sidewall, and nasal dorsum. Long-term follow-up ranging from 1 to 3 years suggests stable volume augmentation in this initial patient series. No donor morbidity was observed in properly selected patients, and enhancements in nasal tip definition were uniformly favorable. Additional studies are needed to more accurately characterize long-term nasal SMAS graft survival in all patients.