The principles of secondary dorsal augmentation are largely the same as those used in primary rhinoplasty. However, owing to the previous surgical disruption of nasal soft tissues, scar contracture and/or fibrosis may complicate or limit secondary dorsal augmentation. Frequently, wide undermining of the soft-tissue envelope is necessary to enable adequate dorsal augmentation. In severe cases preoperative conditioning of the fibrotic skin envelope with stretching exercises and/or repeated massage is necessary to gradually loosen the tethered and noncompliant soft-tissue envelope. Unfortunately, the nose is poorly suited to the use of conventional tissue expanders, and while self- or autoinflating expanders may offer effective alternatives, we have no experience with these devices.