The depressed dorsum of the nose, or saddle nose, is a deformity which is frequently encountered. In mild cases this type of deformity may be camouflaged by rearranging the tissues. In moderate or severe cases, one must resort to the implantation of a graft. The fundamental difficulty in the use of grafts has been their unpredictability. The various materials used have been absorbed, changed in shape, become twisted, caused unfavorable reactions of surrounding tissue, or have been extruded. Since early times surgeons have sought a material for a graft that would approximate the consistency of the deficient tissues, become incorporated as a living part of the nose, and endure the stresses and strains imposed upon it. The problem has been that over a period of many years none of the grafts used have proved to be entirely satisfactory.
In a review of the subject in 1952, McDowell1
SAMUEL M. BLOOM. The Problem of Implants in RhinoplastyIncluding Technique of Obtaining Iliac Crest Grafts. AMA Arch Otolaryngol. 1960;71(5):778–786. doi:10.1001/archotol.1960.03770050038005