Dermal grafting: What is the difference between "dermal only" and "with fat"? Comparing how the bridge of the nose is maintained

Dermal grafting includes a method of folding and inserting dermis alone, and dermal-fat grafting in which fat remains attached. In both cases, some portion is absorbed over time[1]. Dermal-fat grafting has unpredictable absorption patterns, and to compensate, the method of folding dermis alone is being explored[2][1]. Both methods have the advantage of producing natural height even in people with thin skin[2].

What is the difference between "dermal only" and "with fat"?

The main difference is how predictable the result is regarding how much remains. Dermal-fat grafting is absorbed, making the final outcome difficult to predict, which is a disadvantage[2].

The method of folding dermis alone is used to compensate for this greater absorption[1]. A study of 14 subjects showed that the height of the grafted dermis decreased by 38% over 6 months from surgery[1].

Nevertheless, changes in the overall volume of the nasal bridge were small, and the result stabilized after 6 months[1]. However, this is a small-scale study, and further research is needed to apply the results more broadly[1].

Who is a good candidate for dermal grafting?

It is suitable for people with thin nasal skin or insufficient usable cartilage[2]. It is used to supplement volume at the nasal root near the brow and along the nasal bridge[2].

After removing foreign material that was previously injected, dermal-fat grafting is considered a better option than implant (prosthesis) or cartilage for noses with thin, uneven skin[2]. Replacing an implant (prosthesis) with dermal-fat grafting can address thin skin and visibility, but fine blood vessel visibility may persist[2].

How does it differ compared to cartilage and implant (prosthesis)?

When comparing retention, cartilage tends to be absorbed less. Finely minced cartilage is a material that is less readily absorbed than dermal fat or fascia.[2]Costal cartilage also requires much less absorption compared to dermal fat.[2].

While silicone Implant (prosthesis) is convenient, infection and extrusion through the skin are frequently discussed concerns.[3]In one physician's records of 1019 patients, the most common issue was displacement at 4%, and extrusion through the skin occurred in less than 1%.[3]However, it is important to note that this is a report from a single physician documenting the advantages of Implant (prosthesis).

If infection occurs with an Implant (prosthesis), removal becomes necessary.[4]Dermal fat may sometimes be used for reinsertion afterward.[4].

Can any one method be said to be the best?

No. There is no single best method for increasing nasal bridge height, and the material and approach must be selected to suit the individual.[5].

Using your own tissue is more compatible with the body, but it carries the burden of absorption and harvesting from the donor site.[5]Synthetic materials avoid that burden, but carry the risk of displacement or extrusion through the skin.[5].

What should I compare when choosing?

There are three things to compare. First, how much height is needed. Second, the thickness of the nasal skin and any prior nasal treatments. Third, whether you can accept slight lowering due to absorption.

An article alone cannot determine which material suits your nose. At your consultation, communicate the skin thickness, desired height, and any prior experience with Implant (prosthesis) or injection, and confirm where the dermal fat will be harvested from and how much absorption is expected.