Ultra Diced Cartilage Graft in Rhinoplasty: A Fine Tool

We read with great interest the study by Süleyman Taş1 concerning the ultra diced cartilage grafting technique in plastic surgery. In particular, his tool for preparation of the ultra diced cartilage1 deeply attracted us. It is a great idea. However, our letter is in response to several issues that we wish to highlight in relation to this study concerning, for example, the absorption rate of the diced cartilage, its support strength, whether the uneven absorption of diced cartilage can form nasal dorsal irregularities, why the amount of cartilage graft in group 1 (free diced cartilage graft) was significantly less than that in group 2 (ultra diced cartilage graft), and so on. First, the absorption rate of the diced cartilage is not mentioned in this study. Erol2 showed that the absorption of cartilage is a problem that cannot be ignored. It is generally believed that the smaller the particle, the higher the absorption rate. To our surprise, in the Taş study, the rhinoplasty outcome evaluation questionnaire resulted in a 90.6 percent rate in group 2 according to both aesthetic and functional results. Our plastic surgery teams have performed rhinoplasty with different surgical procedures for several decades. Yet, we have been experiencing massive absorption of cartilage after diced cartilage grafting. We can provide real case photographs of patients whose dorsum of the nose collapsed again after the cartilage graft was absorbed 16 months after rhinoplasty (Figs. 1 and 2).Fig. 1.: Nose appearance of a 22-year-old woman 5 weeks after diced cartilage grafting.Fig. 2.: Nose appearance of a 22-year-old woman (same patient as in Fig. 1) 16 months after diced cartilage grafting.Second, we are interested in the support strength of the ultra diced cartilage. How long the nasal shape should be supported and the methods that should be used to protect and shape the nose may need some explanation. Third, the article does not mention whether the uneven absorption of diced cartilage could form nasal dorsal irregularities and what steps should be taken to avoid this outcome. Ledo et al.3 advised that all grafts present the possibility of this problem. Last but not least, why is the amount of cartilage graft used in group 1 (free diced cartilage graft) significantly less than the amount used in group 2 (ultra diced cartilage graft)? This was the case not only when rhinoplasty was used to refine the dorsum but also when rhinoplasty was used for dorsum augmentation. The author reported that the total cartilage volume was decreased from 1 cc to 0.7 cc, which shows that the dead space can be eliminated in this way. We read it as the amount of cartilage graft in the ultra free diced cartilage group was far more than that in the free diced cartilage group. Do we need to collect much more autogenous cartilage for rhinoplasty if we choose the ultra diced cartilage grafting technique? We appreciate Süleyman Taş’s great efforts to clarify important aspects of this topic. This study contributed significantly to the literature concerning cartilage grafting in rhinoplasty. PATIENT CONSENT The patient provided written consent for the use of her images. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Qiuni Gao, M.D.The 16th Department of Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, People’s Republic of China Chuanchang Dai, M.D., Ph.D.Department of Plastic and Reconstructive SurgeryShanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai, People’s Republic of China