Alloderm for nose tip?

Question

asian, have to take out my L implant that has shifted n made my tip VERY thin. a dr said he'll use alloderm on nosetip to protect the thin skin. my nose is flat and bulbous w/o implant. what is alloderm and can it build my nose tip to make it look more caucasian? i want a defined tip. i cant use implant since i have septal perforation and it'll cause infection if i use foreign material. i'd like to have a bridge but self rib will be too invasive

Andrew L. Greensmith, MBChB, FRACS · Answer

A dermis fat graft can really work well - it can make the nasal bridge skin look more healthy and help build the bridge up - it is taken from a non-hairy part of your body say the groin area or anywhere else if you have a scar there already

Toby Mayer, MD · Answer

yes this can be used. Personally I prefer using soft tissue from the scalp and Esr cartilage and no foreign material.  Each surgeon has his preference but I always prefer to use the patient's own tissue to minimize risk.

Jonathan Pontell, MD, FACS · Answer

Hi and thanks for your question.  I would not use alloderm for your tip.  Alloderm is cadaver dermis which is soft and not predictable as far as how much will survive or take.  If you used alloderm, you would have a soft, mushy tip. The tip of you nose is supposed to have cartilage in it.  I would use cartilage from behind your ear to get your tip more projected.  This is very predictable and it is the way that it should be done.  If you go to my website, you will see cases that had cartilage tip grafts.  Good luck.  Dr. Pontell

Myriam Loyo, MD · Answer

hi there,  It looks like you have good answers to your questions from other rhinoplasty surgeons in the forum. I agree some surgeons do use Alloderm and other options are available. I just wanted to point out that if your are considering rib grafting you can consider using donated irradiated rib grafting. It is very safe and has been used for many years now. It is a good option for bridge augmentation.  It does have the risk of warping, meaning twisting. Discuss with your surgeon if this would be advisable in your case. Good luck.

Steven Wallach, MD · Answer

Alloderm is an acellular dermal matrix or basically a skin substitute derived from cadaver skin.  It can help reinforce thin tissues. It will not build up your tip to any great extent.

Michael Yerukhim, MD · Answer

Thank you for your question.

Alloderm is acellular dermal matrix, basically the inside layer of skin (animal or cadaver) cleared of all cells. It's a collagen frameworks that allows body to integrate/grow into it. It is widely used in many surgical specialties for a multitude of applications. In the nose, it is sometimes used as an internal covering to smooth over and hide irregularities. However, in the nose, it also causes quite a bit of swelling that lasts for a long time. It is NOT commonly used in the TIP of the nose.

The need to protect the skin in the tip is certainly there, but I'm not sure Alloderm is the way to go. Plus, Alloderm is unlikely to provide you with significant tip definition. From the limited information you provided, diced cartilage wrapped in temporalis fascia may be a good option to augment the dorsum of your nose, with additional grafts to define the tip. Temporalis fascia can also be used to protect the tip skin. A Facial Plastic Surgeon may be the most comfortable with such an approach.

All the problems you describe with your nose point to your nose being pretty much as challenging as they come - ethnic (Asian) rhinoplasty, prior surgeries (including implant), thinning skin in the tip, and a septal perforation. Do not try to take short cuts and find an easy way with this. Do it right. Find a surgeon with a reputation and experience in performing revision AND ethnic rhinoplasty. It is very likely that you may need several staged procedures to properly address your issues.

Good Luck!

Alloderm for nose tip?

Answers (6)

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