LAUSR

BACKGROUND Dorsal augmentation is one of the most challenging procedures in rhinoplasty. Solid grafts and DC-F have been often used for this purpose with varying success. Warping, irregularities, and variability of final height are some of the potential pitfalls. The aim of this study is to assess the efficiency of our approach combining multiple grafts for nasal dorsal augmentation. OBJECTIVES We describe a technique using a composite dorsal augmentation that is a combination of a foundation layer using high spreader grafts plus a dorsal gap graft combined with a contour layer of three possible types of fascia or DC-F grafts. Combination of the two layers for the nasal dorsum can be varied to achieve the required height that corrects the patient's deformity and achieves the desired aesthetic goals. METHODS Fifty-one patients underwent dorsal augmentation with composite technique between 2017 and 2020 were retrospectively reviewed. A step-by-step algorithm is applied to achieve the required dorsal height. RESULTS The patients are divided into 3 groups, according to the type of contour graft used to increase the nasal dorsal height: double-layer fascia graft, Segmental DC-F or narrow thin Full-Length DC-F. Smooth continuity and increased projection of the nasal dorsum were achieved in all patients. CONCLUSIONS Composite dorsal augmentation is an effective technique for dorsal augmentations requiring 4mm or more of height increase. This technique allows to achieve dorsal augmentation using a combination of grafts from a single donor site together with camouflaging dorsal irregularities and highlighting dorsal aesthetic lines. This algorithm allows optimize greatly the aesthetic profile of our patients.