Some authors have stated that autogenous soft tissue grafts, such as dermal grafts3 or temporalis fascia grafts,5 are satisfactory for covering underlying dorsal irregularities. However, those materials have disadvantages of possible partial resorption and donor-site morbidity. Although some authors have suggested that temporalis fascia grafts are among the most reliable materials and are associated with reasonably low resorption rates,5, 8, 23 those grafts are difficult to manipulate because they are thin and slippery.23-24 Alloplastic materials, such as gelatin film,4 polyglactin 910 (Vicryl suture; Johnson & Johnson Gateway LLC, Piscataway, New Jersey),6 and Gore-Tex (W. L. Gore & Associates Inc, Newark, Delaware),7 have also been advocated for that purpose. However, absorbable synthetics do not last long, and of all graft materials, nonabsorbable synthetics are associated with the highest rates of infection and extrusion.2, 11 A soft-tissue filler, AlloDerm (LifeCell Corp, Branchburg, New Jersey), which is derived from cadaveric skin, is another material frequently used to achieve a smoother nasal dorsum. However, AlloDerm has the definite disadvantage of partial graft resorption, especially when it is positioned over the dorsum in patients with thin skin.
Although the maintenance of typical cartilage viability and a high graft survival rate have been reported with the use of this material, harvesting the temporalis fascia adversely affects the donor site, where either permanent or transient alopecia can develop after surgery.
Many authors have used bare crushed cartilage grafts to conceal dorsal irregularities and to achieve a smoother nasal surface.