Acellular human dermal grafts can be used as connective tissue interpositional grafts in the repair of septal perforations with success rates similar to the use of temporalis fascia, mastoid periosteum, or pericranium. One distinct advantage is the absence of donor-site morbidity. In addition, this graft material is thicker and easier to place and suture and may give more substance to the repaired septum.

Background: Correction of the lower third of the nose is perhaps the most challenging component of performing a rhinoplasty. The tongue-in-groove (TIG) technique provides a method for correcting excess columellar show and maintaining correction of caudal deviation. It is also indicated for controlling nasal tip rotation and projection while preserving the integrity of the lobular cartilaginous complex and may be combined with either the external or endonasal rhinoplasty. It is typically used in combination with other septorhinoplasty maneuvers. The TIG technique consists of a method by which the medial crura are advanced cephaloposteriorly onto the caudal septum into a surgically created space between them.Objective: To determine the effectiveness of the TIG technique to aid in correction of columellar show, a deviated caudal septum, and various tip rotation and projection problems.

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Based on careful and extensive review of the data, we have concluded that IHCC is well tolerated as a grafting material in rhinoplasty and yields superb functional, structural, and cosmetic results in the most complex and challenging operative cases necessitated by previous unsuccessful nasal surgery, septal perforations, and even in autoimmune diseases that led to nasal deformity. Not only did very few complications occur following the use of 1025 IHCC grafts in 357 patients after 386 rhinoplasties over 24 years (rate, 3.25%), but the rate of complications was no greater than rhinoplasty complication rates when AC grafts are used. The results indicate safety and reliability and justify the convenient use of IHCC grafts for primary and revision rhinoplasty without creating donor site morbidity. Irradiated homograft cartilage grafts are quite stable in the nose and maintain structural contour and support in most cases. Irradiated homograft cartilage grafts should be considered as an alternative or even a primary grafting material when the patient does not have adequate quantities of septal or auricular cartilage remaining to provide the correction or when the shape or quality of such an AC does not adequately provide the structure required. Autogenous rib cartilage is also an alternative material but also increases operative and anesthesia time and adds potential morbidity. The use of IHCC is both cost- and time-effective.