The ENTific Centre
Autologous fat graft rhinoplasty
Autologous fat can be used to augment the dorsum of the nose. It has been used as harvested autologous fat globules as well as an injectable autologous fat after harvesting with e.g. a Coleman needle. It has all the above mentioned advantages and disadvantages of autologous tissue grafts. Due to its soft and pliable texture, autologous fat does provides a very natural and soft contoured look, and is excellent camouflaging filler (see Figure 9).
The senior author (CS) recommends autologous fat globules for primary rhinoplasty either as the sole augmenting agent, or in combination with a second stage silicone implant in a two stage stepwise procedure. In the latter technique, the autologous fat acts as a perfect soft contoured fill (see Figure 10). However its application as a salvage implant filler, in the event of a dorsal implant infection and extrusion, is the option of choice for our author CS.
In the author's (CS) opinion, autologous fat globules form the best option for the treatment of any infected and extruding silicone implants. In the event of impending extrusion, the nose is re-explored and the thickened (ex-silicone implant) cavity lining is removed as best as is possible. The cavity is irrigated with an antibiotic solution. The de-augmented nose should not be immediately closed as healing and future shrink-wrapping will cause extensive deep tissue scarring and contractures of the dorsum and tip cartilages. Future revision rhinoplasty will prove extremely difficult to correct well. Autologous fat gobules, harvested from the abdomen or axillae, are inserted immediately into the cavity as a biological augmentative implant (see Figure 11). It is a natural product and resists infection well. Following successful restitution of the infection with a layer of dorsal fat globules, further future dorsal augmentation can be undertaken as a two-step rhinoplasty, but only if absolutely necessary, and preferably with further autologous rib.