Secondary Rhinoplasty: Dice PRF Graft, Prefabricated Graft, and Modified Mastoid Bone Graft

Revision rhinoplasty represents one of the most challenging procedures in nasal surgery, as the surgeon must address distorted anatomy, scar formation, compromised vascularity, and loss of structural support created by prior intervention. Functional impairment frequently coexists with aesthetic deformity, including valve collapse, septal perforation, saddle nose, dorsal irregularities, and tip malposition. Successful management requires restoration of skeletal stability while respecting soft tissue limitations. Preoperative assessment with cone beam computed tomography (CBCT) assists in evaluating residual cartilage, bony framework, and internal valve integrity. In most cases, auricular cartilage remains the preferred donor source because of its versatility and low morbidity. When additional rigidity is required, rib cartilage or a modified mastoid cortical bone graft may be used. This chapter describes practical refinements developed for complex secondary cases, including a periosteum-preserving mastoid graft for dorsal augmentation, a diced cartilage–platelet-rich fibrin (PRF) composite combined with nanofat to enhance graft integration, and a prefabricated auricular cartilage construct for simultaneous correction of external valve collapse and alar deformities through a closed approach. These strategies aim to improve structural durability, promote vascularization, and reduce further tissue trauma in compromised nasal envelopes.