Superficial mastoid fascia as an accessible donor for various augmentations in Asian rhinoplasty

This study was designed to assess the anatomic characteristics and clinical versatility of superficial mastoid fascia as a soft-tissue donor for augmentation in Asian rhinoplasty. Dissections were performed on four fresh cadavers (eight ears) for histologic study. A 3×10 mm2-sized full layer of skin and underlying soft tissue was harvested from the postauricular area, transversely and longitudinally (cephalic and caudal directions), 5 mm apart from the midpoint of the auriculocephalic sulcus. The average fascial thickness and nerve distribution were assessed using digital microscopic images after haematoxylin and eosin (H&E) staining. In the histologic study, the average measured thickness of the superficial mastoid fascia was between 3.8 and 4.5 mm in various directions. Clinically, 33 subjects who underwent rhinoplasty using superficial mastoid fascia were assessed prospectively. When soft tissue was needed in various types of augmentations, a longitudinal incision was made on the posterior auriculocephalic sulcus and the maximum thickness of superficial mastoid fascia was harvested. The sizes of the superficial mastoid fascia used in the 33 subjects ranged from 0.4×2.5 cm2 to 1.2×4.2 cm2. The superficial mastoid fascia was grafted regionally for the nasion, tip and nasal dorsum. In two cases, hypertrophic scars developed at the donor site. Four subjects experienced transient dysaesthesia and hypoaesthesia at the donor area postoperatively. Superficial mastoid fascia may be a useful resource in rhinoplasty as a donor for various types of augmentations, allowing easy access without prominent scarring or permanent sensory nerve damage when a low-to-moderate volume of soft tissue is required.