YIJOM-4153; No of Pages 6 Please cite this article in press as: Amer MA, et al. Effectiveness of chondrofascial ‘cigar’ graft in contouring the nasal dorsum, Int J Oral Maxillofac Surg (2019), https://doi.org/10.1016/j.ijom.2019.03.004 Clinical Paper Cosmetic Surgery Effectiveness of chondrofascial ‘cigar’ graft in contouring the nasal dorsum $ M. A. Amer, M. O. Tomoum, E. M. Shehata, M. F. Mandour: Effectiveness of chondrofascial ‘cigar’ graft in contouring the nasal dorsum. Int. J. Oral Maxillofac. Surg. 2019; xxx: xxx–xxx. ã 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. M. A. Amer, M. O. Tomoum, E. M. Shehata, M. F. Mandour Otolaryngology Department, Tanta University, Tanta, Egypt Abstract. Irregularities of the nasal dorsum after rhinoplasty are frustrating for the patient and the surgeon. Different grafts and implants have been adopted to camouflage this nasal imperfection. This study was performed to assess the outcome of a composite chondrofascial ‘cigar’ graft for contouring an irregular nasal dorsum. Thirty-six patients who underwent rhinoplasty between May 2014 and October 2016 were studied prospectively. The cartilaginous core of the graft was obtained from the septal or conchal cartilage, while the graft outer sleeve was harvested from the right lateral thigh fascia lata. The graft was secured over the nasal dorsum through an external rhinoplasty approach. The patients were followed up for at least 18 months postoperative. All participants were evaluated objectively by two independent rhinoplasty surgeons and subjectively by Rhinoplasty Outcome Evaluation (ROE) score. Donor site morbidity was also assessed. All patients had satisfactory aesthetic results with no apparent irregularities detected over the nasal dorsum. The ROE score improved, from a mean of 20.94 Æ 8.67 (range 8–58) preoperatively to a mean of 79.56 Æ 10.65 (range 50–96) postoperatively. Insignificant donor site morbidity was encountered, with inconsequential effects. The chondrofascial cigar graft is a reliable method for contouring dorsal irregularities, particularly in patients with thin nasal skin. Key words: wrapped diced cartilage; nasal dorsal contouring; cigar graft. Accepted for publication 7 March 2019 Rhinoplasty operations are one of the most common aesthetic procedures. The achievement of desirable results in such procedures depends on appropriate plan- ning, the tissue characteristics of the pa- tient, and the surgeon’s capabilities 1 . Gaining a nasal dorsum with a flattering appearance after rhinoplasty is challeng- ing, as it requires precise preoperative planning, accurate intraoperative imple- mentation, and strict postoperative care 2 . Historically, a depressed irregular nasal dorsum was commonly the result of syph- ilitic destruction of the bony and cartilagi- nous support of the nasal dorsum. Over time, the causes of saddle nose have chan- ged, with infectious and toxic causes be- coming less frequent. Trauma and primary and secondary reduction rhinoplasties now represent the main causes of these deformities 3,4 . Anatomically, the cartilaginous septum and maxillary crest form the main support of the lower two-thirds of the nasal dorsum. Int. J. Oral Maxillofac. Surg. 2019; xxx: xxx–xxx https://doi.org/10.1016/j.ijom.2019.03.004, available online at https://www.sciencedirect.com $ Level of evidence: Level 4, prospective case series. 0901-5027/000001+06 ã 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.