The Chrysalis Graft: Combination of Diced-Cartilage-Fascia Grafts and PRP in Augmentation Rhinoplasty

Introduction: This dorsal nasal augmentation technique utilizes a combination of the diced-cartilage with Platelet-Rich- Plasma (PRP), Platelet-Poor-Plasma (PPP) and fascia graft in a chrysalis form, which provides a regenerative and moldable technique. Methods: Patients requiring dorsal augmentation underwent rhinoplasty using diced-cartilagein a PRP-clot carrier, wrapped in a sleeve of deep-temporal fascia in achrysalis form. The PRP fraction was extracted after blood centrifugation and used to carry the diced-cartilage graft. The PPP and middle platelet layers were used as fibringlue sprayed over the chrysalis graft avoiding the use of stitches. Results: A total of 31 patients, with a mean age of 42 years old underwent augmentation rhinoplasty with this technique. The mean follow-up was 14 months. Donor sites for cartilage included nasal septum (n=13), concha (n=6), combination of both septum and concha (n=5) and rib (n=7). The surgical approach was open rhinoplasty in 20 cases and closed approach in 11 patients. No major complications requiring surgical revision were observed. No extrusions, no graft displacement and no skin irregularities were observed. Three cases (9.67%) of partial graft resorption were observed. Other complications included one case of local infection and two keloids in ear donor site. Satisfactory nasal dorsal augmentation was achieved in all other cases. Conclusions: This report describes a technique of dorsal augmentation using a mixture of diced-cartilage grafts, PRP, PPP and deep temporal fascia graft in a chrysalis manner. This approach offers a moldable and regenerative construct for nasal augmentation without major complications and minimal graft resorption