Use of osseocartilaginous paste graft for refinement of the nasal dorsum in rhinoplasty.

In both primary and secondary rhinoplasty, establishment or refinement of nasal dorsal aesthetic lines is of paramount importance. Many different techniques used to create a cosmetically acceptable nasal dorsum have been published. The material to be used in nasal dorsal contouring should create a harmonic contour and should be easily shaped, long-lasting, and resistant to infection. Resection of the hump yields an osseocartilaginous complex as a single unit when an osteotome is used. Use of a rasp gives a good amount of fragmented material comprising bone, cartilage, soft tissues, and blood. The authors used this material as a paste graft to refine the nasal dorsum in rhinoplasty and retrospectively evaluated the outcomes. A retrospective chart review of 77 patients who underwent this procedure between 2003 and 2009 was performed. The follow-up period ranged from 22 to 40 months (median, 28 months). The postoperative evaluations included clinical examination and digital photographic documentation. The satisfaction of each patient was assessed with a questionnaire completed at the 12th postoperative month. The described graft, which combines the advantages of cartilage and bone, was shown to be clinically durable. This combination also results in an ideal texture and consistency for molding due to its diced form. The texture of this graft enables the surgeon to give a final shape to the nasal dorsum bimanually. In this study, a paste graft was shown to be a versatile and reliable composite material for nasal dorsal contouring and refinement.