Yonsei Med J.  2015 Jan;56(1):167-174. 10.3349/ymj.2015.56.1.167.

Various Applications of Deep Temporal Fascia in Rhinoplasty

• Park SW
• Kim JH
• Choi CY
• Jung KH
• Song JW

• KMID: 2352803
• DOI: http://doi.org/10.3349/ymj.2015.56.1.167

Abstract

PURPOSE
In Asians, nasal dorsal and tip augmentation procedures are usually performed at the same time, and most dorsal augmentations use implants. In this study, dorsal augmentation was given by various types of grafts using deep temporal fascia (DTF) for primary rhinoplasty cases using only autologous tissues to improve the curve of hump noses and depressions. For secondary rhinoplasty cases, DTF was used to improve implant demarcation and transparency. Such effectiveness and utility of DTF is discussed.
MATERIALS AND METHODS
Between May 2009 and May 2012, we performed rhinoplasty using DTF in 175 patients, which included 78 secondary surgery patients and 128 female patients. The mean age of the patients was 31.4. DTF was utilized with various types of grafts without implants to improve the curve in dorsal augmentation of hump noses and cases that required curve betterment. DTF was used to improve implant demarcation and transparency for secondary cases.
RESULTS
The mean follow-up duration was 1.5 years. Of the 175 patients, 81% were satisfied with the natural correction achieved, whereas 19% complained of undercorrection, which was resolved with additional surgery. No specific complications such as nasal inflammation or contractures were observed.
CONCLUSION
DTF can be used with various graft methods for correction of radix, dorsal, and tip irregularities. It can also be used to correct implant contour transparency in secondary rhinoplasty and thus may be considered as a useful supplementary graft material in rhinoplasty for Asians.

Keyword

Deep temporal fascia; rhinoplasty

MeSH Terms

Adult
Cartilage/surgery
Fascia/*surgery/*transplantation
Female
Humans
Male
Nose/surgery
Prostheses and Implants
*Rhinoplasty
Transplantation, Autologous

Figure

• 

  Fig. 1 DTF harvest. (A) The incision design for the harvest on the temporal region, located vertically upward in a straight line along the posterior border of the sideburn. (B) Glistening DTF can be identified when subcutaneous tissue and superficial temporal fascia are uncovered. In this image, the superficial temporal fascia is lifted up. The STF can be contained in the harvest. DTF, deep temporal fascia; STF, superficial temporal fascia.

• 

  Fig. 2 Harvested DTF. (A) DTF harvested alone. (B) DTF harvested with STF. As loose connective tissue is attached to the superficial surface, it can be utilized as a soft tissue supplement that can form a smoothly movable plane. DTF, deep temporal fascia; STF, superficial temporal fascia.

• 

  Fig. 3 Wrapping diced cartilage with DTF. (A) Injecting diced septal cartilage into DTF bag. (B) Radix graft. DTF, deep temporal fascia.

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  Fig. 4 Combined graft with cartilage. (A) Taking out and wrapping the rib cartilage with DTF. (B) Combined radix graft with conchal cartilage. (C) Combined graft with the derotation graft placed in supratip area. (D) Combined onlay graft with conchal cartilage. DTF, deep temporal fascia.

• 

  Fig. 5 DTF free graft. (A) Preparing radix graft by folding DTF into several layers. (B) Fixing radix graft by penetrating the suture through nose root skin with a needle. (C) Free DTF graft on radix. (D) Inserting DTF as a free graft in a case of supratip break. DTF, deep temporal fascia.

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  Fig. 6 DTF free graft for implant coverage. (A) After total capsulectomy, biofilm is visible inside the infected capsule. (B) Thinned dorsal skin after total capsulectomy. (C) DTF being grafted together covering the implant. DTF, deep temporal fascia.

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  Fig. 7 Case 1. Patient with deviated nose correction. Combined graft with diced cartilage as radix graft. (A and C) Preoperative photos. (B and D) 6 month postoperative photos.

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  Fig. 8 Case 2. Patient with demarcated dorsal rib cartilage correction. Combined graft with full length rib cartilage. (A and C) Preoperative photos. (B and D) 6 month postoperative photos.

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  Fig. 9 Case 3. Patient with hump nose and broad bony vault correction. Free radix graft. (A and C) Preoperative photos. (B and D) 7 month postoperative photos.

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  Fig. 10 Case 4. Patient with contracted nose correction. Free graft for coverage of implant demarcation. (A and C) Preoperative photos. (B and D) 6 month postoperative photos.

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