What rhinoplasty surgeon has not been frustrated by unmet expectations from unreliable graft materials? The quest for an ideal graft continues. Septal cartilage is not always adequate in amount or substance. Ear cartilage may cause unsightly irregularities over time. Cranial bone or rib harvest sites add to the complexity of the procedure and can be intimidating for many operators. This article describes the authors' successful experience with AlloDerm onlay grafts for the correction of nasal contour deformities in 58 primary and secondary rhinoplasty cases by means of the open and endonasal approaches. Forty-two patients received an open-approach procedure; the remaining 16 received grafting through an endonasal or closed approach. Thirty-seven of the patients were secondary rhinoplasty patients, and some underwent multiple nasal corrections. The indications, intraoperative surgical technique of graft placement, and representative results will be discussed. Long-term follow-up showed good results, though partial graft resorption occurred in some patients. Overall, this experience with AlloDerm for nasal augmentation was encouraging.

An enlarged labium minus can be bothersome for functional, aesthetic, and social reasons. Labia minora hypertrophy can be congenital or acquired by chronic irritation, exogenous androgenic hormones, or stretching with weights. This can cause inflammation, poor hygiene, interference with sexual intercourse, or intermittent urinary self-catheterization in myelodysplastic women. Aesthetically, an asymmetric or enlarged labium minus causes self-consciousness sexually and when the subject wears tight pants. Previously, labia minora reduction was performed by amputation of the protuberant segment and oversewing the edge, or a wedge of protuberant labial tissue was excised and reapproximated. However, the former technique removes the natural contour and color of the edge of the labium minus, and the latter can result in an incomplete or tight reduction. Therefore, rather than an amputation or a wedge resection, we preserved the natural contour and anatomy of the labium minus by simply reducing its central width through bilateral deepithelialization and reapproximation of the central portion with preservation of the neurovascular supply to the edge. Six patients have undergone this reduction method with excellent results without specific complications.