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Nasal dorsal augmentation in rhinoplasty using synthetic implants remains an intensely controversial surgical practice. The authors describe their experience with expanded polytetrafluoroethylene (e-PTFE) sheeting as an implant material in rhinoplasty. A review of the literature and detailed descriptions of techniques for creating synthetic dorsal implants are offered. Alloplastic implants are powerful tools which may be used by the thoughtful surgeon in carefully selected patients to achieve nasal dorsal augmentation.