Dorsal Augmentation with AlloDerm

ABSTRACT

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.

AlloDerm - rhinoplasty - dorsum - dorsal augmentation - dorsal graft

REFERENCES

• 1 Sheen J H. The ideal dorsal graft: a continuing quest.  Plast Reconstr Surg. 1998;  102 2490-2493
• 2 Constantian M. Rhinoplasty in the graft-depleted patient.  Oper Tech Plast Reconstr Surg. 1995;  2 67-81
• 3 Gryskiewicz J M, Rohrich R, Reagan B. The use of AlloDerm for the correction of nasal contour deformities.  Plast Reconstr Surg. 2001;  107 561-570
• 4 Schwartz B M. The use of AlloDerm for the correction of nasal contour deformities [doscussion].  Plast Reconstr Surg. 2001;  107 571
• 5 Gryskiewicz J M, Rohrich R, Reagan B. AlloDerm used in rhinoplasty [brief communication and reply].  Plast Reconstr Surg. 2001;  108 1828
• 6 Rohrich R J, Reagan B J, Gryskiewicz J M. The role of AlloDerm in the correction of nasal contour deformities. In: Gunter JP, Rohrich RJ, Adams WP Dallas Rhinoplasty: Nasal Surgery by the Masters. St. Louis, MO; Quality Medical Publishing 2001: 870-881
• 7 Rohrich R J, Reagan B, Adams W et al.. Early results of vermilion lip augmentation using acellular allogeneic dermis: an adjunct in facial rejuvenation.  Plast Reconstr Surg. 2000;  105 409-416
• 8 Jackson I T, Yavuzer R. AlloDerm for dorsal nasal irregularities.  Plast Reconstr Surg. 2001;  107 553-558
• 9 Wainwright D, Madden M, Luterman A et al.. Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns.  J Burn Care Rehabil. 1996;  17 124-136
• 10 Reagan B J, Madden M, Huo J et al.. Analysis of cellular and decellular allogeneic dermal grafts for the treatment of full-thickness wounds in a porcine model.  J Trauma. 1997;  43 458-466
• 11 Kridel R W, Foda H, Lunde K. Septal perforation repair with acellular human dermal graft.  Arch Otolaryngol Head Neck Surg. 1998;  124 73-78
• 12 Tobin H, Karas N. Lip augmentation using an AlloDerm graft.  J Oral Maxillofac Surg. 1998;  56 722-727
• 13 Gryskiewicz J M. AlloDerm lip augmentation [brief communication and reply].  Plast Reconstr Surg. 2000;  106 953
• 14 Gryskiewicz J M. Waste not, want not: the use of AlloDerm in secondary rhinoplasty.  Plast Reconstr Surg. 2005;  116 1999-2004