Usefulness of Cross-Linked Human Acellular Dermal Matrix as an Implant for Dorsal Augmentation in Rhinoplasty

Yang CE, Kim SJ, Kim JH, Lee JH, Roh TS, Lee WJ.

What this paper says

In 18 patients followed 8 to 38 months, processed donated human dermis used to build up the bridge held its height except in the two patients where it was placed under the periosteum, with mean satisfaction 81.02 out of 100.

Overview

Asian rhinoplasty more often adds height to the bridge than reduces it, and the choice of material for that has long been contested between the patient's own cartilage and synthetic implants. This retrospective review reports the authors' experience with a third option: human skin tissue processed to remove all cells.

Sections of note

18 patients who had augmentation rhinoplasty using acellular dermal matrix from April 2014 to November 2015, reviewed retrospectively.
Follow-up ranged from 8 to 38 months.
Contour change was assessed by two independent plastic surgeons comparing before and after photographs.
Patient satisfaction was measured with six questions covering aesthetic and functional aspects.
Dorsal height did not decrease over time except in two patients whose material was grafted into a subperiosteal pocket.
Patients with supraperiosteal implantation showed acceptable maintenance of dorsal height.
No major complication was reported; overall satisfaction scored 81.02 out of 100. Level of evidence IV.

What it means for a patient

This material avoids a second incision to harvest cartilage and, unlike silicone, is processed human tissue.
Where in the tissue layers it is placed appears to matter: the two cases that lost height were placed in a deeper plane.
Limits: 18 patients, retrospective, one center, no comparison group against cartilage or synthetic implants, and follow-up as short as 8 months in some patients.
Resorption of implanted tissue can continue past 3 years, so the longest follow-up here does not settle durability.

Why this paper matters

Dorsal augmentation material remains the central unsolved choice in Asian rhinoplasty, weighing donor site morbidity against implant complications. This reports a third path with early stability. The small sample and absence of a control arm leave the comparison open.

Terms

Acellular dermal matrix: Donated human skin processed to remove all cells, leaving the collagen scaffold.
Cross-linked: Chemically treated so the collagen fibers bond, slowing breakdown.
Dorsal augmentation: Building up the bridge of the nose.
Alloplastic: Made of synthetic material.
Subperiosteal and supraperiosteal: Beneath, or above, the membrane covering the nasal bone.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“Asian noses are relatively small and flat compared to Caucasians; therefore, rhinoplasty procedures often focus on dorsal augmentation and tip projection rather than reduction in the nasal framework. Various autologous and alloplastic implant materials have been used for dorsal augmentation. Recently, human acellular…”

Excerpt; the full abstract is on PubMed.