An overview of nasal dorsal augmentation.

Structural deficiencies of the nasal dorsum most commonly derive from congenital, traumatic, and iatrogenic etiologies. Alternatively, dorsal deficiency may be a manifestation of a generally underprojected nose with otherwise appropriate relationships between the radix, dorsum, and tip. In analyzing dorsal deficiency, associated anatomic abnormalities leading to compromise of both aesthetic form and respiratory function must be recognized and incorporated into the reconstructive plan. The cornerstone of augmentation rhinoplasty employs either autologous graft or alloplastic implant material to restore dorsal height and structural support to the nasal skeleton. Many autologous and alloplastic materials are currently available to the rhinoplasty surgeon, each of which carries a characteristic profile of relative advantages and limitations. Although most rhinoplasty surgeons prefer autologous materials, the choice of material must be individualized to each patient. The reconstructive plan ultimately formulated emerges after thoughtful consideration of the extent of the dorsal deficiency, characteristics of the overlying skin-soft tissue envelope, history of prior surgery, associated structural abnormalities, preferences of the surgeon, and views of the patient. Regardless of the specific methods used to augment the nasal dorsum, optimizing the aesthetic profile and maximizing respiratory function in a sustainable manner with minimal patient risk and morbidity remain the primary objectives.