This article describes the authors’ successful experience with AlloDerm and Dermaplant onlay grafts for the correction of nasal contour deformities in secondary rhinoplasty. Sixty-seven secondary rhinoplasty patients underwent multiple nasal corrections. Long-term follow-up in the subgroup of patients for 2 years or longer showed good results, though partial graft resorption (defined to be equal to or less than 50 percent) occurred in 45 percent of our patients. We have found it is necessary to overcorrect defects. This experience for nasal augmentation in secondary rhinoplasty was encouraging. Grafts are useful for dorsal augmentation and for correcting an overresected dorsum, irregular dorsum, collapsed lateral walls, the “inverted V” deformity, an open roof, and for camouflage over autogenous grafts. The major indication for our use of the graft was dorsal augmentation to create a soft, smooth bridge and thus avoid the untoward sequelae of warping or irregularities. All 67 patients in this series were followed for 6 months to five years. Analysis demonstrated no contour changes between year 1 and year 2, showing the dermal grafts to be stable after 1 year. Immediate problems and how they were handled will be described. AlloDerm and Dermaplant, which are two brands of allogeneic dermis processed to remove all cellular elements, possess several qualities that make them valuable for rhinoplasty. As off-the-shelf products, they are readily available and reasonably affordable. As shown in this series, they are versatile and easy to use in secondary rhinoplasty patients who are often graft-depleted. After careful preoperative analysis, the grafts are shaped to recontour the nasal skeleton as needed. Partial absorption, especially over the bony dorsum in a thin-skinned patient, is a definite disadvantage. Re-grafting is possible and sometimes necessary. Complete absorption was not seen in our study, and long-term persistence at 2 years was seen in some secondary rhinoplasty patients.
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