Objectives Assessment of outcome and patient satisfaction following augmentation rhinoplasty with cartilage & Permacol and safety of Permacol. Methods Permacol is a biomaterial derived from porcine dermis, modified by chemical processing. Patients with Permacol augmentation were compared with a historical cohort of patients who had cartilage augmentation. Patients, who had cartilage grafts, were retrospectively reviewed for a period of 3 years, from 2001 to 2004. Patients in the Permacol group were prospectively studied from 2003 to 2006. The senior author performed all operations. All the patients had supra-tip depression. The outcome was measured by clinical assessment, evaluation of photographs, and patient satisfaction. Results A total 24 patients had augmentation rhinoplasty-12 with cartilage and 12 with Permacol. Their age ranged from 19 to 54 years (mean 30). The mean follow-up for cartilage grafts was 33 months and for Permacol 26 months, with a minimum of 12 months for both groups. Cartilage grafts were harvested from the septum in 7 patients and from the pinna in 5 patients. All 12 patients with cartilage augmentation had satisfactory outcome. In the Permacol group, 11 out of 12 were satisfactory with the outcome. In 1 patient, Permacol graft extruded within 2 months. Conclusions Permacol graft compared very well, in terms of outcome and safety, with cartilage for augmentation of nasal dorsum. Apart from 1 case of extrusion (8%), there were no other complications. Permacol graft is readily available and easy to handle and contour. Long-term follow-up is needed for further assessment.