Reply: Ultra Diced Cartilage Graft in Rhinoplasty — Clinical Outcomes

I would like to thank Dr. Gao and Dr. Dai for their compliments regarding my article.1 In this communication, I will answer their considerate questions one by one. The absorption rate was completely demonstrated in the study.1 Group 1 (free diced cartilage group) had 84 patients, and group 2 (ultra diced cartilage group) had 75 patients who had completed their 1-year follow-up. The absorption rate in group 1 was 12 percent (10 of 84 patients), and in group 2, it was 4 percent (three of 75 patients). This study exposed that absolutely small cartilages have a three times smaller absorption rate. Figure 1 shows a severe and complicated case to highlight the success of the ultra diced cartilage technique. [See Figure, Supplemental Digital Content 1, which shows before-and-after profile views of the patient on the operating table, http://links.lww.com/PRS/F328. See Figure, Supplemental Digital Content 2, which shows preoperative and 1-year postoperative frontal views, http://links.lww.com/PRS/F329. See Video (online), which is a 90-degree TAS video that gives full transparency of the patient’s preoperative and 1-year postoperative appearance from all angles.] In addition, there is a special chapter on Asian rhinoplasty in my upcoming book2 that shares my philosophy and techniques for this particular patient group. Video.This is a 90-degree TAS video that gives full transparency of the patient’s preoperative and 1-year postoperative appearance from all angles. Fig. 1.This case is a nice demonstration of the treatment for a challenging nose. The patient underwent surgery 9 years earlier and presented to us for a revision surgery. Her problems at admission were low radix, S-shaped crookedness, droopy and bulbous tip, left alar base retraction, alar flaring, hump, and breathing problems on both sides. A closed surgery was used to fix these problems. Since all of her septal tissue was removed in her previous surgery, rib cartilage was harvested from sixth right rib via inframammary incision. L-strut support of the septum was reconstructed with septal extension and caudal septal strut grafts. One cc of ultra diced cartilage was injected for radix and dorsal augmentation. Figure, Supplemental Digital Content 1, shows that all of her problems were fixed with a high aesthetic result, http://links.lww.com/PRS/F328. Moreover, the 1-year postoperative views shown in Figure, Supplemental Digital Content 2, http://links.lww.com/PRS/F329, and the Video (online) highlight that the aesthetic result was preserved without any absorption, dislocation, or irregularities. It is surprising to see how the nose did not swell during the surgery and there was no distortion or an unpredictable result. It is also amazing to see the result is exactly same without any absorption at 1 year postoperatively. Of course, this good result cannot be just about the ultra diced cartilage technique but also my rhinoplasty concept, which is shared during my closed atraumatic rhinoplasty courses3 each November and also in my upcoming book.2 With regard to the support strength of the ultra diced cartilage and uneven absorption or dorsal irregularities, preparing of the appropriate pocket is one of the most important factors in obtaining a successful result. The pocket that will receive the ultra diced cartilage graft needs to have enough space but also be tight enough to eliminate the dislocation. Of course, there is a learning curve, as in all surgical techniques, and with experience, the presented success rates will be inevitable. Otherwise, the casting period is 7 days. After cast removal, I prefer not to apply any bandages. The amount of cartilage graft used was significantly lower in group 2 (ultra diced cartilage group) because the dead space in the grafts could be eliminated by the technique. Thus, the nose could be shaped exactly with ultra diced cartilage, which is truly a compact and stable tissue, rather than free diced cartilage, as demonstrated in Video 2 of the article.1 However, to achieve this compact tissue (ultra diced cartilage graft), you need more cartilage than is needed with the free diced cartilage technique. PATIENT CONSENT The patient provided written consent for the use of her images. DISCLOSURE The author has no conflicts of interest, commercial associations, or intent of financial gain regarding this research. Süleyman Taş, M.D.TAŞ Aesthetic Surgery ClinicHakki Yeten Cad No. 11Terrace Fulya, Center 1, Apt. 97Şişli, Istanbul 34349, Turkeydrsuleymantas@live.comInstagram, Twitter: @drsuleymantas REFERENCES 1.Taş S. Ultra diced cartilage graft in rhinoplasty: A fine tool. Plast Reconstr Surg. 2021;147:600e–606e. 2.Taş S. Rhinoplasty in Practice: An Algorithmic Approach to Modern Surgical Techniques. Boca Raton, Fla: Taylor & Francis Group, CRC Press; 2022. 3.Taş S. Closed Atraumatic Rhinoplasty Course 3. November 20–21, 2021, Istanbul, Turkey. Available at: https://drsuleymantas.com/course/. Accessed August 11, 2019. Supplemental Digital Content PRS_150_3_2022_07_26_TAS_PRS-D-21-02116_SDC1.pdf (4.14 MB) PRS_150_3_2022_07_26_TAS_PRS-D-21-02116_SDC2.pdf (4.17 MB) Image Gallery Fig. 1.This case is a nice demonstration of the treatment for a challenging nose. The patient underwent surgery 9 years earlier and presented to us for a revision surgery. Her problems at admission were low radix, S-shaped crookedness, droopy and bulbous tip, left alar base retraction, alar flaring, hump, and breathing problems on both sides. A closed surgery was used to fix these problems. Since all of her septal tissue was removed in her previous surgery, rib cartilage was harvested from sixth right rib via inframammary incision. L-strut support of the septum was reconstructed with septal extension and caudal septal strut grafts. One cc of ultra diced cartilage was injected for radix and dorsal augmentation. Figure, Supplemental Digital Content 1, shows that all of her problems were fixed with a high aesthetic result, http://links.lww.com/PRS/F328. Moreover, the 1-year postoperative views shown in Figure, Supplemental Digital Content 2, http://links.lww.com/PRS/F329, and the Video (online) highlight that the aesthetic result was preserved without any absorption, dislocation, or irregularities. It is surprising to see how the nose did not swell during the surgery and there was no distortion or an unpredictable result. It is also amazing to see the result is exactly same without any absorption at 1 year postoperatively. Of course, this good result cannot be just about the ultra diced cartilage technique but also my rhinoplasty concept, which is shared during my closed atraumatic rhinoplasty courses3 each November and also in my upcoming book.2