I don’t do rhinoplasty surgery anymore. The nose is a tricky place to operate on. What is “just a little bump” or “a little indent” requires a big surgery frequently to fix it. But if you know anything about my practice, you know I love fat transfer. I put it all over the face, and yes, sometimes that involves part of the nose.
The journal article is one out of Taiwan. “Microautologous Fat Transplantation for Primary Augmentation Rhinoplasty: Long term monitoring of 198 Asian Patients.” It was in the June 2016 Aesthetic Surgery Journal. Asian patients frequently want to make their noses bigger, because they are too flat and short. The traditional way to fix this has been to use some kind of implant to do this. The implants can be synthetic, like gortex or silicone, or natural, like cartilage, bone, or skin. Doing these implants have given good outcomes, though synthetic materials have higher rates of issues like movement and extrusion, where it comes out of the tissue. Natural tissue can have problems with inconsistent volume, hard shape control, and absorption.
So enter fat. The issue with fat in the nose is similar to the issue with fat in the breast. Fat does not respond well to pressure, and the skin on the nose is tight (unlike the skin on most of the rest of the face). Tight skin = pressure. Pressure = fat doesn’t survive. hen fat doesn’t survive, there can be cysts and uneven or poor survival of the fat.
Study:
- 198 patients. Mean age 45 years.
- No prior surgery, filler, implants or trauma to the nose.
- Extendable skin
- They used a MAFT Gun. (Microautologous fat transplantation gun. This can adjust the size of the fat injected.)
Markings
- They made an I shape from the nasal tip to a point 15mm above the intercanthal line. This then fanned out near the junction to the forehead.
- This was divided into 3 zones.
Procedure
- Fat was harvested at low pressure. Then centrifuged.
- Transferred into 1cc syringes.
- Fat was delivered in sizes of .0067 to .0056 with each trigger.
- Average of 3.4 cc was done.
- Fat was” meticulously transplanted” in 2-3 layers from the deepest to the most superficial layers.
- Downward traction was applied, starting at the upper third and working down. The nasal tip was done last.
- No massage was done. They were placed into adhesive tape to alleviate swelling.
Findings:
- Less than 50% of fat survived.
- 63% had one session of grafting. 35% had 2 sessions.
- No major complications: infection, skin loss, nodules, or asymmetry were seen.
- Improvements were seen in wrinkles, shrinkage of pores, and better skin texture. (yay stem cells!)
My thoughts?
I liked seeing their thought process and techniques. I love to transfer fat, and already do it on the nose in the upper portion. This isn’t magic, and as with all fat grafting, I am sure results will vary. But I love that this is a way to shape the nose which doesn’t involve a foreign object (silicone implant) or more extensive surgery (like cartilage and bone grafting). And that stem cell effect. I love it.
I think I may become more of a rhinoplasty surgeon again- just with fat.