Journal of Plastic, Reconstructive & Aesthetic Surgery
Superficial mastoid fascia as an accessible donor for various augmentations in Asian rhinoplasty
Section snippets
Histologic study using fresh cadaver
The histologic study of SMF from the retroauricular area was performed using four fresh cadavers. Three specimens of different direction were harvested from eight different postauricular areas. First, we determined the central point 5 mm from the midpoint of the auriculocephalic sulcus, and then the full layer of tissue (from skin to periosteum), measuring about 3 × 10 mm2 sized transversely, was harvested. For the longitudinal section, the same-sized full layer of tissue was harvested from the
Histologic study
Although the fascial layer was difficult to identify with certainty, we measured the average thickness between the subdermis and posterior auricular muscle. The average measured thickness of the SMF was 3.82 ± 0.42 mm in the transverse section, 4.44 ± 0.68 mm in the cephalic vertical section and 4.58 ± 0.80 mm in the caudal vertical section (Table 1). The posterior auricular nerve was atypically distributed around the posterior auricular muscle and was not located above the posterior auricular
Discussion
In Asian rhinoplasty, autologous grafts are indispensable for better nasal profiles. Regional augmentation is frequently needed at the nasion, bony dorsum, middle vault, supratip area, tip, lobule and, sometimes, the perialar area. Even after reconstructing the main nasal framework, minor fine grafts are needed at the end of the procedures, but most Asian surgeons are limited in supply of autologous tissues for these augmentations. For smoother and more natural tips, soft tissues such as
Conclusion
Although SMF is not large enough to fill an entire dorsum from nasion to tip, as compared with a dermo-fat graft from the trunk, it may provide an appropriate amount of soft tissue for regional augmentation. When unplanned soft tissue is needed intra-operatively, this may be the most convenient donor site. In our clinical study, SMF offered sufficient volume for a nasal root, and part of a nasal dorsum and tip-lobule augmentation, leaving a concealed donor-site scar.
Conflict of interest
None.
Funding
None.
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