Nasal Reconstruction

Correction of a saddle nose deformity

Saddle nose deformities make the nose appear “scooped” from the side view and wide on the frontal view. In addition, patients with saddle nose often have severe nasal obstruction. The nasal deformity and nasal obstruction both occur because of a lack of support of the septum. Saddle nose deformities are most often caused by a fractured septum that can no longer provide support to the bridge of the nose. In other cases, they are caused by a septal perforation(large hole in the septum.)

Saddle nose deformities may be corrected by rebuilding the structural support that was lost by the trauma or the perforation. The surgeon may use a cartilage graft from the ear or the rib if needed. The goal of nasal reconstruction for saddle nose deformity is to improve nasal breathing and to create a straight nasal bridge.

Nasal reconstruction after Mohs surgery and removal of skin cancer

Removal of skin cancer lesions, especially in the delicate areas of the head and neck, may impact both the function and appearance of the nose. The goal of nasal reconstruction after Mohs surgery is to create a nose that is as close to the preoperative appearance as possible, while also ensuring proper nasal function.
A variety of reconstructive techniques may be used to restore nasal function and to create an aesthetic result, depending upon the size and location of the defect. Your surgeon will work with you to determine the best reconstructive option.

nasal repair

The "H" zone: facial areas commonly affected by skin cancer.

Reconstructive Techniques for Nasal Repair after Mohs Surgery

Primary Closure

For small defects on the nose in cases where the skin may be brought together easily without distorting the normal anatomy.

Skin Grafts

For lesions that are too large for primary closure a skin graft may be used. The skin graft is usually taken from behind the ear or then sutured into the area of the defect. The disadvantage of skin grafts (especially on the nose) is that the color and thickness of the skin graft may not perfectly match the skin on the nose. Your surgeon will discuss the risks and benefits with you in more detail.

Local Flaps

Local flaps are the most common method for repairing defects on the nose. This technique allows surgeons to repair the defect with skin of similar color and thickness as the skin that was removed. Occasionally, a small piece of cartilage from the ear is also needed to restore the shape and function of the nose.

Pedicled Flaps

For large nasal defects, a pedicled flap is often recommended to provide the best cosmetic and functional result. This type of reconstruction requires at least two procedures. The first procedure is usually performed in the main operating room under sedation or general anesthesia for patient comfort, and the second procedure is usually performed under local anesthesia. You and your surgeon will decide what is best for you.

For pedicled flaps, the surgeon reconstructs the nose using skin from the forehead or the cheek with the skin’s native blood supply. The transferred skin is still dependent upon its native blood supply for many weeks after surgery. Once the transferred skin has developed a new blood supply from the surrounding skin, the native blood supply is no longer needed. At this point, the second procedure is performed to divide the native blood supply and to contour the nose. Sometimes another procedure is needed to thin the skin of the flap before the native blood supply is cut.

A pedicled flap is a complex reconstructive procedure. Further details of the surgery will be discussed with your surgeon during your consultation.

Secondary Procedures

The reconstructive surgeon’s goal is to provide patients with a nose that is as close to their old nose as possible. We follow our patients closely after surgery, and if we note that redness or a thickened scar may be developing, we may recommend scar massage or small doses of steroid injections to break down the scar as it forms. If the scar is reddened, we may prescribe a special bandage to wear at night. For persistent redness that does not respond to topical treatment, we also have the option to refer patients to our Laser Center.

The drawings on this page were originally published in Facial Surgery: Plastic and Reconstructive. Mack L. Cheney, Tessa A. Hadlock. CRC Press, 2014.