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The nasolabial flap is an excellent choice for use in reconstruction of the nasal alar subunit due to its inherent properties that match skin tone and the convexity of the nose. Often overlooked as an option to use in nasal reconstruction, the nasolabial flap can be very advantageous. Indications for the nasolabial flap can be expanded to include reconstruction of the nasal tip, dorsum, soft triangle, and partial alar defects. [ABSTRACT FROM AUTHOR]

Nasal defect repair has been one of the more challenging areas of reconstructive surgery due to the lack of uniform nasal skin thickness and complex contours. Currently, algorithms for medium to large nasal soft tissue defects have been well defined by various authors. Small defects, arbitrarily defined as 1 cm or less, still present significant challenges. In this article, the authors examine the options available to repair small soft tissue nasal defects and the appropriate situations in which each method is best suited. [ABSTRACT FROM AUTHOR]

Combined cheek and nose soft tissue defects can represent a formidable challenge to the reconstructive surgeon. It is important for the surgeon to think of these defects as four separate categories: cheek with nasal sidewall, cheek with nasal sidewall and exposed bone, cheek with nasal sidewall plus ala, and cheek with simple posterior ala defect. This categorization will help the surgeon plan the repair and provide a successful aesthetic outcome. There are multiple repair options that the surgeon can use, and the surgeon should be facile with all types. It is universally agreed that the cheek defect must be repaired prior to undertaking the repair of the nasal defect. [ABSTRACT FROM AUTHOR]

The forehead flap is one of the oldest recorded surgical techniques for nasal reconstruction. As the gold standard for nasal soft tissue reconstruction, the forehead flap provides a reconstructive surgeon with a robust pedicle and large amount of tissue to reconstruct almost any defect. Modifications provided by masters like Burget and Menick have only increased the utility of this exceptional flap. Maintaining an axial pattern, utilizing the pedicle ipsilateral to the defect, extending the flap at right angles with caution when extra length is needed, using a narrowpedicle, and early subperiosteal dissection are the guiding principles for forehead flap reconstruction of the nose. In addition, lining defects can be addressed simply and reliably with a folded forehead flap. [ABSTRACT FROM AUTHOR]

The authors provide an overview of nasal soft tissue reconstruction and of the senior author's practice. Nasal soft tissue reconstruction is a challenging endeavor as the nose is one of the most prominent and complex facial features. A multitude of surgical repair options exist, which can make the decision-making process unnecessarily complicated. It is advisable that the reconstructive surgeon become facile with a handful of surgical techniques versus trying to master many techniques. [ABSTRACT FROM AUTHOR]

Patients needing surgical repair after nasal Mohs surgery require immediate prescreening by an anesthesiology provider to determine if the patient is a candidate for the appropriate anesthetic or is to be delayed for more medical evaluation. These patients may need anesthesia anywhere on the spectrum from local anesthesia only to general endotracheal anesthesia, and this may affect where and when the plastic surgeon can proceed. [ABSTRACT FROM AUTHOR]

Surgical revisions are inherent in nasal reconstruction. It is of benefit to the patient if the surgeon is able to accurately counsel the patient on the sequence and expectations prior to embarking on a multistage nasal reconstruction. The requirement to "wait a year" is an unnecessary patient burden, but almost all results improve with time. [ABSTRACT FROM AUTHOR]