Augmentation in rhinoplasty--a personal view

This paper presents a view on the use of various synthetic materials in rhinoplasty and the authors' preference for autologous bone as an augmentation material. The biology of bone transplantation as it applies to rhinoplasty is reviewed. Specific techniques for augmentation of the major saddle deformity are described, emphasizing the use of the external rhinoplasty approach for exposure as well as the authors' view that the dorsal graft should not extend beyond the cephalic border of the lower lateral cartilage. The senior author's experience with autologous bone as an augmentation material in 60 patients with major saddle deformities is reviewed. There were three patients whose grafts totally resorbed, and two cases of late graft fracture and displacement. The remaining patients had resorption graded as minor or insignificant. There were only two donor site complications--both wound seromas. Patients reviewed had been followed from one to 18 years.