Total Nasal Reconstruction

Total Nasal Reconstruction involves the reconstruction of the nasal bone, cartilage, skin and mucosa from a significant trauma. The trauma may be mechanical as frequently seen from car, bicycle, or other accidents. Trauma to the nose may also result from a chemical irritant that can atrophy the mucosal lining of the septum, leading to cartilage exposure, breakdown and eventual collapse of the the cartilaginous bridge of the nose. Such a deformity can result from cocaine abuse and is typically termed the cocaine nose that can include a saddle nose deformity. Other causes include vascular compromise as seen infrequently from injection of fillers in the peri-nasal area that can cause infarction of the surrounding tissue, leading to skin necrosis and deformity.

When addressing a complex nasal reconstruction, it is important to analyze the defect and determine what tissues need to be reconstructed, including the inner lining of the nose, the cartilage and bone, and the overlying skin. Because of the multiple layers needing reconstruction, total nasal reconstruction typically involves multiple stages as follows:

  • First stage: obtaining tissue for lining of the nose usually from a forehead flap that is folded to provide internal lining as well as outer skin cover
  • Second stage: Once the first stage has healed, the flap is reelevated and structural support for the nose is added typically using a rib graft. The rib graft can provide dorsal support and columellar support for adequate tip projection. The forehead flap can also be thinned in this stage to ensure a nice contour to the nose.
  • Third stage: The forehead flap is divided and inset. Small cartilage grafts from the ear can be used to help correct any contour irregularities in this stage.

Visit us at Thomassen Plastic Surgery to learn how Total Nasal Reconstruction can help you.