Minimal Invasive Rhinoplasty: Fat Injection for Nasal Dorsum Contouring

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Dear Editor,
We read with interest the article entitled Minimal Invasive Rhinoplasty: Fat Injection for Nasal Dorsum Contouring, where Lin et al1 presented the case series of 13 consecutive patients treated with autologous fat injection at the nasal dorsum region to improve facial esthetics.
Analyzing their results with preoperative and postoperative 3-dimensional photography images, the authors observed a satisfying fat graft retention rate for nasal dorsum augmentation.
We would like to congratulate with Lin et al1 for their interesting article that confirms the autologous fat grafting positive effects in the nasal region.
Moving from our experience about fat grafting with reconstructive and regenerative purpose,2,3 we adopt this technique also in the nasal region in several conditions.
Differently from the authors, we mainly use this technique in secondary rhinoplasty to approach dorsal line in case of small irregularities, to correct columellar scar retraction and in case of valvolar stenosis to obtain lysis of fibrotic tissue and functional improvement.
Such defects can reduce the quality of rhinoplasty both under a functional and aesthetical point of view.
As the authors describe in this anatomical region, the use of needles is indicated4 because they determine a precise injection with low complication rate especially for secondary cases where they allow to easily overcome scar tissue resistance in retracted columellar for instance.
In our case series, we present a longer follow-up up to 1 year and, although not supported by imaging as in Lin et al's article, we observe a good fat retention in this anatomical region with permanent correction of the preoperative deformity. In addition to that, in our experience, autologous fat grafting allows better results if compared with fillers because we adopt them only in selected cases for minor deformities.
Regarding the processing method to obtain fat graft, we adopt Coleman technique because we demonstrated5 that centrifugation can augment the number of stem cells while reducing the number of proinflammatory blood cells. In our biological study, we collect for each patient, both a centrifuged adipose tissue sample using the Coleman technique and a noncentrifuged sample. Comparing adipose-derived stem cells from both the centrifuged fraction and the noncentrifuged fraction, we observe that the number of recovered cells was higher in the centrifuged donors with an increased clonogenic potential confirming the promising effect of processing fat with Coleman technique.
In conclusion, Lin et al's work confirms how autologous fat grafting can be adopted in the nasal region with positive and reproducible results, and further studies are needed to confirm the long-term effects.

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