Autologous Fascial Grafting for Alar Base Depression: A Novel Technique in Asian Rhinoplasty

Nasal base depression is a frequent aesthetic concern in rhinoplasty, particularly in patients with midfacial retrusion. This study introduces a fascia transplantation technique to correct alar base (paranasal) depression and restore nasal-facial harmony through structural support of the alar base.

A retrospective analysis was conducted on 52 patients who underwent fascia grafting during open rhinoplasty. Fascia placement was performed primarily for alar base/paranasal augmentation; changes in tip projection or nasolabial angle, when present, were not direct surgical targets of the fascia graft. Fascia was harvested from postauricular or rectus abdominis regions, depending on the cartilage source. Nasal morphology was evaluated pre- and postoperatively using standardized anthropometric measurements. Alar base depression was quantitatively assessed through grayscale image analysis using ImageJ. Patient satisfaction was measured with a modified Rhinoplasty Outcome Evaluation (ROE) scale. Complications were monitored via clinical examination, standardized photography, and a structured questionnaire addressing symptoms such as foreign-body sensation, graft displacement, and local discomfort.

Following fascia-based nasal base augmentation, significant aesthetic improvements were observed. Alar width and base width changes were minimal and statistically insignificant. Postoperative grayscale analysis showed a significant decrease in values (from 0.720 to 0.583, P < 0.05), indicating reduced alar base depression following fascia grafting. The mean postoperative ROE score increased notably, with no major complications such as foreign-body sensation or graft displacement reported.

Fascia transplantation provides stable augmentation of the alar base/paranasal region with a favorable safety profile; any observed changes in tip projection or nasolabial angle should be interpreted as secondary (indirect) effects rather than direct targets of fascia placement. It represents a safe and effective autologous option for achieving durable, harmonious aesthetic outcomes in rhinoplasty.

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