Dorsal Augmentation with AlloDerm

The augmentation-reduction principle is becoming pervasive in nasal surgery. Rhinoplasty surgeons have discovered that nasal skin does not consistently contract. Therefore, nasal augmentation is an increasingly accepted technique, and grafts are required. Autogenous cartilage is the grafting material of choice. There are drawbacks to autogenous material, especially in secondary rhinoplasty patients who are often graft-depleted. Cartilage grafts may cause unsightly irregularities over time. Therefore, an interest in alternative soft tissue substitutes has developed. AlloDerm is freeze-dried acellular cadaver dermis. AlloDerm acts as a filler to expand portions of the nasal skin envelope to balance the overresected nose and adhere to the augmentation-reduction principle. AlloDerm facilitates touch-ups, especially in the author's own personal patients. It is soft, thin, and pliable and can be placed under very thin skin. AlloDerm obviates the necessity for graft harvest. It is safe in that it can eliminate the risk of donor-site problems for dorsal onlays such as cranial bone or rib grafts. It is natural and acts as an excellent camouflage graft when used as padding over a cartilage graft. It is incorporated into the surrounding tissue and does not develop unsightly irregularities over time. Extrusion is rare. It does not shift over time. It is especially useful in donor-site-depleted patients. Overcorrection is absolutely necessary because a portion of the implanted AlloDerm is always absorbed. Resorption is most common over the bony dorsum with about 20 to 30% of the graft absorbing. Resorption is disappointing for the patient and frustrating for the surgeon. Absorption does not seem to relate to the number of layers used. No graft absorption has been noted after 1 year. Therefore, it is safe to assume that the patient has a stable result from the AlloDerm graft after 1 year, and no further change should be anticipated. It is easy to use. The advantages and caveats should be kept in mind when evaluating a patient for a dorsal graft.