Fascial ball graft in Asian rhinoplasty: a tunable, non-translucent option for tip definition and augmentation

Abstract

Thin-skinned Asian rhinoplasty is frequently complicated by cartilage visibility and oversharpening of the nasal tip. We introduce the fascial ball graft as a tunable on-lay technique for nasal tip augmentation and camouflage. A retrospective review was conducted of 227 patients (43 males, 184 females) who underwent fascial ball graft placement between 2020 and 2025 at a single rhinoplasty center. Patients were divided into two groups: Group A (n = 84), in which the fascial ball served as the sole on-lay augmentation graft; and Group B (n = 143), in which the fascial ball was placed over an auricular cartilage cap for layered augmentation. The fascial ball was constructed from autologous fascia (posterior auricular, temporalis, or costal perichondrium) using a 5-0 polydioxanone (PDS) purse-string suture, allowing intraoperative adjustment of thickness (3-6 mm) and firmness. Shine-through (0-3 scale), tip curvature radius, and FACE-Q (a validated patient-reported outcome measure for facial aesthetic procedures) “Satisfaction With Nose” scores were evaluated. Mean follow-up was 18.2 months (range 6-24 months). Shine-through was grade 0-1 in 87% of cases. Tip curvature radius significantly increased from 7.4 ± 0.8 mm preoperatively to 10.3 ± 1.0 mm at 12 months (P < 0.001), indicating improved roundness while avoiding bulbosity. FACE-Q scores increased from 52 ± 12 to 92 ± 8 (P < 0.001). No major complications were noted. The fascial ball on-lay graft provides tunable augmentation and non-translucent soft-tissue coverage, effectively achieving desired tip projection while preventing cartilage visibility in both primary and revision Asian rhinoplasty.

Keywords

Asian rhinoplasty / fascial graft / nasal tip / camouflage / projection

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