Allografts in Rhinoplasty

The practice in rhinoplasty tends to go toward reduction rhinoplasty, except Asian noses. The more resection is done, the more complications arise. The poor durability of aesthetic outcomes and the progressive functional impairment associated with reductive surgery have provided a major drive for the development of grafting approaches in rhinoplasty. Dorsal and middle vault depression is the frequently seen outcome that yields tip over-rotation, loss of tip projection, retraction of the columella, and unnatural contours. Disfiguring and functionally crippling are the final results of these noses. The best choice for graft material is the patient’s own cartilage, but in some primary cases with severe deformities (trauma etc.) or secondary cases, there may be a lack of appropriate material for reconstruction. In these situations, there are other choices such as using an allograft or an alloplastic material. Allograft, meaning a tissue from other individuals of the same species, may be the next best alternative to an autograft. Allogeneic cartilage seems an attractive alternative to autogenous cartilage grafts, mainly because of its apparent similarity. Allografts are not limited in quantity, and there is no donor-site morbidity. The allograft matrix is invaded and replaced by adjacent connective tissue and may show reduction in volume over time. Because of the long-term unpredictability in resorption, relatively high infection rate, and the possibility of warping, homografts must be used carefully.