What Is AlloDerm in Rhinoplasty?

Hi. I want to talk a little bit about AlloDerm. If you come in for a consultation with me, you may have heard me talk about it, or you may have read about it online or seen other doctors talk about it. In patients who have very thin skin, we need to augment the skin thickness slightly. Now, that can be done using the temporalis muscle. There is a muscle right here on the scalp, and it's got a nice thick layer. We can make an incision on the scalp, open up the hair, get into the muscle, take the lining of the muscle, which is a nice, thick, glistening layer, and use it in rhinoplasty, on the bridge. I used to do that quite a bit over a decade ago. The problem is, it's a second operative site. You may lose some hair in this area. You can certainly get an infection or get a bleed in that area.

So the other alternative is AlloDerm. AlloDerm is acellular dermis. It's basically donated cadaver skin that doesn't have any cells in it, so there's really no risk of rejection. Anything can get infected. A primary rhinoplasty can get infected. Any incision anywhere on the body can get infected. But there's no additional risk of infection or rejection. It's as safe as it can possibly be. There is no need for immune therapy, like when you get a heart transplant or a lung transplant. This is not like that at all. It's just a little bit of scaffolding. Think of it as carpet padding underneath the carpet. If you have extremely thin skin on the bridge of the nose or the tip of the nose, as things heal, you may start noticing edges of cartilage and bone. So to give it a little nice softness, you need some carpet padding under that very, very thin carpet.

So what is AlloDerm? Well, here it is. If you zoom in, you can actually see this is the material. It's basically skin, and you can see how thin it is. Some people have this expectation that it's something very thick. Well, here's how the package comes. It's a pre-treated package. It's gone through strict, strict criteria to make sure there's nothing in there: no viruses, no bacteria, nothing that can transmit any infections. The reason I'm opening this is that it has expired. We have not used it. It has an expiration date, so I'm going to just open it and waste it, essentially. But this is what AlloDerm is. It comes in a sterile package, and what the nurses in the OR do is open this up and reconstitute it. It comes as a solid, essentially. It's been treated. So this is what the AlloDerm is. It's very thin. It has a little backing, and the backing comes off as it gets reconstituted. You can see the backing comes up. The reconstitution is essentially putting this in a solution, and what I use is gentamicin, an antibiotic solution, to make sure it soaks in there.

It comes in different sizes. In breast reconstruction, much larger pieces can be used. They can be stacked. They can be used in a variety of ways. But for rhinoplasty, I use a thin segment. I don't need much. It's just essentially, like I said, carpet padding. It's not a structural graft. There have been studies out there that talk about AlloDerm as a replacement for cartilage grafts. It's not going to work for that. It's simply a way of Photoshopping thin skin, to give it a nice softness by adding a little bit more resilience to it. So this goes into the solution for about 10 to 15 minutes, reconstitutes and becomes a nice, thin, flexible piece of skin. This is a larger segment of it. This would be used for something larger. Again, this is just a sample. The actual product comes wrapped like this.

So if you see or hear about AlloDerm, this is what it is. It's a perfectly fine substance. There are a lot of different substitutes out there. A lot of different companies try to make it. This is the only one so far that is really safe to use in the nose, that doesn't form a capsule around itself. It integrates. So if you go back into the nose six months or a year later, you can't even tell what's the AlloDerm and what's not. It just fuses into the tissue. The patient's own cells grow through it, and it becomes a part of you. Now, you can see that there is a little color difference, because it's a graft, but essentially it's a part of it. It's not a plastic. It's not something foreign. And it's a fantastic option for rhinoplasty: revision, primary, any type of rhinoplasty. It works well for that purpose. So I wanted you to know what AlloDerm is, in case we talk about it. Thank you.