Aesthetic Reconstruction of the Tip of the Nose

Abstract

The nasal tip is a thin structure, often just 3 or 4 mm thick. There is little need to inform an audience of Mohs histographic surgeons that as a defect becomes progressively deeper it goes in the space of a few short millimeters from superficial to full-thickness perforation. Tissue defects of little significance to the structure and aesthetics of the nose (and requiring a simple solution) can at first glance look the same as defects of great significance. Attainment of the aesthetic result, rather than a merely reparative one, requires that the wound be analyzed anatomically and three-dimensionally, tissues be replaced in like kind, the wound be braced with a lamina of cartilage (or bone), the internal hard tissue framework be given a refined aesthetic shape (at Stage II), and the mantle of carefully selected donor skin and subcutaneous fat be a work of sartorial excellence.

Superiorly Based Nasolabial Interpolation Flap for Repair of Complex Nasal Tip Defects

“…[1][2][3] The median forehead flap is the more traditional interpolation flap used for medium to large nasal tip defects because of its large size and relative pliability, and because many consider it a better color and texture match. These include simple measures such as immediate or delayed full-thickness skin grafting with donor sites from the pre-or postauricular areas to local tissue transfer procedures such as the bilobed transposition flap.…”

A dorsal nasal advancement flap for off-midline defects

“…Full-thickness skin grafts used for defects of limited depth with adequate vascular bases can give satisfactory results if the nasal skin is smooth and thin rather than thick and sebaceous. 2 However, the circular junction between the graft and surrounding skin may reveal the artificial nature of the construct. 3 If laxity is sufficient, bilobed or dorsal nasal rotation flaps are options that can give outstanding results in the appropriate situations.…”

The Versatility of the Nasolabial Flap Enhanced by the Delay Procedure

“…Another option is to use mucosal advancement flaps, a cartilage graft, and cutaneous coverage flaps, 8 or turnover forehead flap combined with a composite graft 9 . The main disadvantage of this method is its relative complexity.…”