Success and Complication Rates of Different Techniques and Materials Used for Nasal Dorsal Augmentation in Rhinoplasty

Abstract Background Autologous materials, homograft and alloplastic implants are commonly used in nasal dorsal augmentation. So far, there is no satisfactory evidence to ascertain the safest, efficient, and superior in aesthetic outcomes among different materials. Thus, we aimed to conduct a systematic review and metaanalysis (SR, MA) of published literature to review rates of outcomes and complications of different materials used for nasal dorsal augmentation, in trial for better future surgical results. Methods Thirteen electronic databases were searched from inception through December 2018 and a manual search in October 2019. Results A total of 280 eligible studies were included, of which 165 articles were included in the meta-analysis. Compared to others, alloplastic expanded polytetrafluoroethylene (alloplastic e-PTFE) was considered first place, for having the highest graft scores in most of its outcomes; secondary deformity, resorption, patients’ satisfaction, displacement, extrusion, seroma, graft deviation, swelling, and hematoma outcomes with rates of (2%, 0.6%, 96.5%, 1.3%, 1.2%, 1%, 1%, 0.8%, 0.8%)respectively. Alloplastic silicone came after e-PTFE, for its superior results in revision rhinoplasty, success rate, aesthetic function, and scarring outcomes (4.1%, 99.9%, 98.8%, 2.7%) respectively. Autologous bone graft came at the last place as it had the least graft scores in patients’ satisfaction, displacement, perforation, and hematoma outcomes (50.7%, 9.3%, 8.3%, 5.4%)respectively. Autologous diced cartilage was superior in those outcomes; edema, bruising, and donor site complications (7.1%, 7.4%, 4.4%) respectively. Autologous costal cartilage had the highest graft scores in necrosis and graft exposure outcomes (4.3% and 1.9%), while it had the lowest graft scores in warping and success rate (7.1% and 87.3%). Autologous auricular cartilage had the highest graft scores in warping and foreign body reaction outcomes (1.4% and 6.3%), while it had the lowest graft scores in nasal obstruction and donor site complications rate (72.7% and 33.3%). Infection was the most common reported complication in MA, where autologous alar cartilage had the lowest infection rate of 0.2%, unlike alloplastic Medpor recorded the highest risk of 6.6%. Conclusions Regarding our results, we concluded that alloplastic e-PTFE yielded superior position in comparison to other materials, that would succeed as an alternative to convential autologous grafts, as had superior results in most of nasal dorsal augmentation outcomes. On the other hand, autologous bone graft was in the last place in all its outcomes. Future studies are needed to improve reporting of races variety, follow-up times, and diverse participants, as to resolve uncertainty regarding the ideal material for dorsal augmentation in rhinoplasty, with concentrating on proper assessment of races variety, which will improve selecting the proper graft implant.