Facial Plast Surg 2021; 37(05): 590-598
DOI: 10.1055/s-0041-1723785
Original Research

Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty Utilizing Fat Transfer Combined with Platelet-Rich Fibrin

Milos Kovacevic
1   HNO-Praxis Hanse-Viertel, Hamburg, Germany
Aaron M. Kosins
2   Department of Plastic Surgery, University of California, Irvine School of Medicine, Irvine, California
Abdülkadir Göksel
3   Rhinoistanbul, Istanbul, Turkey
Frank Riedel
4   HNO-Zentrum Rhein-Neckar, Mannheim, Germany
Gregor Bran
5   GB Aesthetics London, London, Great Britain
Johannes A. Veit
4   HNO-Zentrum Rhein-Neckar, Mannheim, Germany
6   Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Mannheim, Germany
› Author Affiliations


A thin or damaged skin soft tissue envelope may cause concerns in primary and secondary rhinoplasty. During postoperative healing, unpredictable scarring and contraction may occur and lead to significant aesthetic and trophic sequelae. Besides a meticulous surgical technique, there are no reliable techniques to prevent long-term skin damage and shrinkage. Fat transfer with addition of platelet-rich fibrin (PRF) harbors the possibility of local soft tissue regeneration and skin rejuvenation through growth factors and mesenchymal stem cells. It may also facilitate the creation of a thin fat layer on the dorsum to prevent shrink-wrap forces and conceal small irregularities. The goal is to provide evidence for the feasibility, durability, and beneficial effect of diced macrofat transfer bonded with PRF on the nasal dorsum. We present the technique of fat transfer conjugated with PRF as a nasal dorsal graft. Clinical endpoints were the prevention of trophic disturbances and atrophy at a 1-year postoperative follow-up. We present the skin mobility test as a clinical indicator of a healthy soft tissue envelope. The presented case series consists of 107 rhinoplasties. Fat was harvested in the umbilical or costal region. PRF was created by centrifugation of autologous whole blood samples. Macrofat was diced, cleaned, and bonded with PRF. The compound transplants were transferred to the nasal dorsum. There were no perioperative complications or wound-healing issues. Mean follow-up was 14 months. Clinical inspection showed good skin quality and no signs of shrinkage, marked scarring, or color changes with positive skin mobility test in all patients. Survival of fat was confirmed by ultrasonography and magnetic resonance imaging. Diced macrofat transfer in conjunction with PRF to the nasal dorsum is a feasible and safe method. A beneficial effect on the soft tissue envelope is demonstrated as well as the prevention of shrink-wrap forces.

Publication History

Article published online:
26 February 2021

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  • References

  • 1 Kosins AM. Comprehensive diagnosis and planning for the difficult rhinoplasty patient: applications in ultrasonography and treatment of the soft-tissue envelope. Facial Plast Surg 2017; 33 (05) 509-518
  • 2 Toriumi DM, Mueller RA, Grosch T, Bhattacharyya TK, Larrabee Jr WF. Vascular anatomy of the nose and the external rhinoplasty approach. Arch Otolaryngol Head Neck Surg 1996; 122 (01) 24-34
  • 3 Kerolus JL, Nassif PS. Treatment protocol for compromised nasal skin. Facial Plast Surg Clin North Am 2019; 27 (04) 505-511
  • 4 Rosenberger ES, Toriumi DM. Controversies in revision rhinoplasty. Facial Plast Surg Clin North Am 2016; 24 (03) 337-345
  • 5 Çakır B, Oreroğlu AR, Doğan T, Akan M. A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments. Aesthet Surg J 2012; 32 (05) 564-574
  • 6 Saban Y. Rhinoplasty: lessons from “errors” : from anatomy and experience to the concept of sequential primary rhinoplasty. HNO 2018; 66 (01) 15-25
  • 7 Gabrick K, Walker M, Timberlake A, Chouairi F, Saberski E, Steinbacher D. The effect of autologous fat grafting on edema and ecchymoses in primary open rhinoplasty. Aesthetic Surg J 2020; 40 (04) 359-366
  • 8 Nguyen PS, Baptista C, Casanova D, Bardot J, Magalon G. Rhinoplastie et injection de tissu adipeux autologue. Ann Chir Plast Esthet 2014; 59 (06) 548-554
  • 9 Coleman SR. Facial recontouring with lipostructure. Clin Plast Surg 1997; 24 (02) 347-367
  • 10 Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E. Procedure, applications, and outcomes of autologous fat grafting. Ann Med Surg (Lond) 2017; 20: 49-60
  • 11 Hassan WU, Greiser U, Wang W. Role of adipose-derived stem cells in wound healing. Wound Repair Regen 2014; 22 (03) 313-325
  • 12 Clauser L, Zavan B, Galiè M, Di Vittorio L, Gardin C, Bianchi AE. Autologous fat transfer for facial augmentation: surgery and regeneration. J Craniofac Surg 2019; 30 (03) 682-685
  • 13 Sinno S, Wilson S, Brownstone N, Levine SM. Current thoughts on fat grafting: using the evidence to determine fact or fiction. Plast Reconstr Surg 2016; 137 (03) 818-824
  • 14 Krastev TK, Beugels J, Hommes J, Piatkowski A, Mathijssen I, van der Hulst R. Efficacy and safety of autologous fat transfer in facial reconstructive surgery: a systematic review and meta-analysis. JAMA Facial Plast Surg 2018; 20 (05) 351-360
  • 15 Erol OO. Microfat grafting in nasal surgery. Aesthet Surg J 2014; 34 (05) 671-686
  • 16 Kao W-P, Lin Y-N, Lin T-Y. et al. Microautologous fat transplantation for primary augmentation rhinoplasty: long-term monitoring of 198 Asian patients. Aesthet Surg J 2016; 36 (06) 648-656
  • 17 Verboket RD, Anbar B, Söhling N. et al. Changes in platelet-rich fibrin composition after trauma and surgical intervention. Platelets 2020; 31 (08) 1069-1079
  • 18 Srinivas B, Das P, Rana MM, Qureshi AQ, Vaidya KC, Ahmed Raziuddin SJ. Wound healing and bone regeneration in postextraction sockets with and without platelet-rich fibrin. Ann Maxillofac Surg 2018; 8 (01) 28-34
  • 19 Kovacevic M, Riedel F, Wurm J, Bran GM. Cartilage scales embedded in fibrin gel. Facial Plast Surg 2017; 33 (02) 225-232
  • 20 Smith OJ, Kanapathy M, Khajuria A. et al. Systematic review of the efficacy of fat grafting and platelet-rich plasma for wound healing. Int Wound J 2018; 15 (04) 519-526
  • 21 Choukroun J, Adda F, Schoeffler CVA. An opportunity in peri-implantology: the PRF. Implantodontie 2001; 42: 55-62
  • 22 Jang YJ, Song HM, Yoon JY, Sykes JM. Combined use of crushed cartilage and processed fascia lata for dorsal augmentation in rhinoplasty for Asians. Laryngoscope 2009; 119 (06) 1088-1092
  • 23 Guerrerosantos J. Temporoparietal free fascia grafts in rhinoplasty. Plast Reconstr Surg 1984; 74 (04) 465-475
  • 24 Lin T-M, Huang S-H, Lin Y-N. et al. Fat grafting for facial contouring (nose and chin). Clin Plast Surg 2020; 47 (01) 91-98
  • 25 Papadopulos NA, Wigand S, Kuntz N. et al. The impact of harvesting systems and donor characteristics on viability of nucleated cells in adipose tissue: a first step towards a manufacturing process. J Craniofac Surg 2019; 30 (03) 716-720
  • 26 Gode S, Ozturk A, Kısmalı E, Berber V, Turhal G. The effect of platelet-rich fibrin on nasal skin thickness in rhinoplasty. Facial Plast Surg 2019; 35 (04) 400-403
  • 27 Liu R, Long Y, Liu L, Zhao X. Effect of platelet-rich fibrin on fat grafting in animal models: a meta-analysis. Aesthetic Plast Surg 2020; 44 (02) 570-578
  • 28 Yu P, Zhai Z, Lu H, Jin X, Yang X, Qi Z. Platelet-rich fibrin improves fat graft survival possibly by promoting angiogenesis and adipogenesis, inhibiting apoptosis, and regulating collagen production. Aesthet Surg J 2020; 40 (09) NP530-NP545
  • 29 Toriumi DM. Dorsal augmentation using autologous costal cartilage or microfat-infused soft tissue augmentation. Facial Plast Surg 2017; 33 (02) 162-178