Zyplast (Collagen Corporation, Palo Alto, CA) has been used as a temporary implant to camouflage contour abnormalities of the nasal dorsum during the convalescent period of rhinoplasty and to temporize before revision surgery. It also may be helpful to act as a spacer to prevent scar contracture of the nasal tissues before augmenting with a more permanent implant. The expense and transient longevity are negative points for its use. In addition, a skin test is necessary before injection to identify patients who might be sensitive to bovine collagen. Some surgeons recommend two skin tests separated by 30 days to identify additional patients who might demonstrate sensitivity.
Purified acellular human dermal graft (AlloDerm, Life Cell Corporation, Woodlands, TX) is an acellular graft produced from fresh human cadavers by a process that removes the epidermis and the cells from the dermis without altering the extracellular architectures. Although originally used as a dermal scaffolding for skin grafts in burn patients, it has been advocated as a dorsal onlay graft and for use as a draping graft in conjunction with other dorsal implants. The long-term resorption rate is unknown.17'18
must be exercised in employing this technique in revision rhinoplasties, where there is less vascularity over the nasal dorsum, to prevent difficulties in wound healing and implant extrusion.
Gilmore23 has recommended using alloplastic mesh as a "draping graft" to cover dorsal implant irregularities and for more uniform contouring.
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