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Nasal Reconstruction of Large Defects Without a Forehead Flap
Defects over 2.0 to 2.5 cm may often require repair with a multistaged forehead flap. However, in some such defects, other options may be available. In this article, the author will review some of these options. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - March 6, 2024 Category: Cosmetic Surgery Authors: John L. Frodel Source Type: research

Nasal Reconstruction
If I have seen further than others, it is by standing upon the shoulders of giants. —Isaac Newton (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - March 6, 2024 Category: Cosmetic Surgery Authors: Anthony P. Sclafani Tags: Foreword Source Type: research

Prevention and Management of Complications in Nasal Reconstruction
Nasal reconstruction is a challenging practice with the potential for complications. Surgeons can prevent complications through preoperative optimization of patient factors, refinement of intraoperative surgical techniques, and postoperative surgical and nonsurgical wound care. Preoperatively, optimization of modifiable and recognition of nonmodifiable risk factors is paramount. Intraoperatively, meticulous flap design and surgical technique promote healing. In the postoperative setting, attentive wound care, adjuvant therapies, and close follow-up for consideration of additional procedures enhance outcomes. By anticipatin...
Source: Facial Plastic Surgery Clinics of North America - March 4, 2024 Category: Cosmetic Surgery Authors: Hannah N. Kuhar, Ryan Nesemeier, Leslie R. Kim Source Type: research

Management of Traumatic Nasal Avulsion Injuries
Soft tissue injuries to the midface (and nose) are common causes for seeking trauma care. As trauma patients, observing advanced trauma life support protocols is warranted given the risk of concomitant injuries. Here, options for optimizing tissue preservation, microvascular replantation, non-microvascular tissue replacement, and wound stabilization are discussed. Included in this discussion are data-driven predictors for successful replantation as well as technique descriptions with anatomic references to guide surgeons in choosing optimal donor vessels. In both partial and complete avulsion injuries, venous congestion is...
Source: Facial Plastic Surgery Clinics of North America - February 13, 2024 Category: Cosmetic Surgery Authors: Scott Bevans Source Type: research

Decision Making in Nasal Reconstruction
In this review, the paramedian forehead flap indications and uses are reviewed, specifically examining clinical situations where patient selection is important. In these settings, a preoperative discussion with a patient regarding surgical expectations and goals in the setting of their defect is paramount. The authors review the literature regarding the psychosocial aspects of major nasal reconstruction and review preoperative discussion points that are key to a well-informed patient and improved patient satisfaction through the nasal reconstructive process. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - February 12, 2024 Category: Cosmetic Surgery Authors: Virginia E. Drake, Jeffrey S. Moyer Source Type: research

Nasal Lining Reconstruction with Loco-regional Flaps
The reliability of local intranasal flaps speaks to the robust vascularity of the nose, which these flaps are based on. The goals for lining replacement, as in any other area of head and neck reconstruction, is to use tissue that best matches the qualities of what is being replaced. The goal of this review is to describe the extent to which local tissues can be used and when to consider regional flaps when the extent of a local flap will not provide enough coverage. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - February 12, 2024 Category: Cosmetic Surgery Authors: Alexander E. Graf, Lee Kaplowitz, Sydney C. Butts Source Type: research

Structural Support for Large to Total Nasal Reconstruction
This article will review approaches to the reconstruction of structural support in large nasal defects. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - February 12, 2024 Category: Cosmetic Surgery Authors: Corin M. Kinkhabwala, Krishna G. Patel Source Type: research

Total Nasal Reconstruction
Total nasal reconstruction is a complex challenge due to the need to establish new internal lining, internal structural support, and external skin covering that is both functional and esthetic. The medial femoral condyle corticoperiosteal free flap represents an innovative option for restoration internal structure and internal nasal lining. When used in conjunction with a paramedian forehead flap, acceptable results in both function and esthetics can be achieved. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - February 8, 2024 Category: Cosmetic Surgery Authors: Brittany E. Howard, Samip Patel, William W. Shockley, Joseph Madison Clark Source Type: research

Major Nasal Reconstruction: Rising to the Challenge
Even a small nasal defect presents a significant challenge for the reconstructive surgeon. The functional and aesthetic demands of an ideal reconstruction are tremendously high when aiming for a flawless reconstruction of the most central feature of the face. The complexity of this task increases exponentially for large nasal defects or those that involve structure and lining in addition to skin. Reconstruction of extensive subtotal or total nasal defects is a daunting endeavor often faced only a handful of times throughout a reconstructive surgeon ’s career. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - January 25, 2024 Category: Cosmetic Surgery Authors: Samuel L. Oyer Tags: Preface Source Type: research

Implications of Malignancy, Radiation, and Timing of Major Nasal Reconstruction
Owing to the complex, multilayered anatomy of the nose in the central face, major nasal reconstruction can pose a significant challenge for reconstructive surgeons. It is the responsibility of reconstructive surgeons to have an understanding of the most common cutaneous malignancies and excisional techniques that may lead to complex nasal defects. The purpose of this article is to discuss these malignancies, excisional techniques, and impacts of radiation on tissue that has implications for reconstructive surgeons. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - January 9, 2024 Category: Cosmetic Surgery Authors: Jin Soo Song, Stephen P. Smith, Chaz L. Stucken Source Type: research

Revision Nasal Reconstruction After Previous Forehead Flap
Reconstructing the nose poses considerable challenges, even for the most skilled surgeons. Significant nasal reconstructions often require later revisions to address persistent issues in both form and function, and it is crucial to discuss this possibility with the patient before embarking on the reconstructive process. Minor revisions can often be managed by making direct incisions between nasal subunits, coupled with soft tissue sculpting or the use of structural grafts for augmentation. When minor adjustments prove insufficient, the initial reconstruction may need to be entirely revised with a second forehead flap. (Sou...
Source: Facial Plastic Surgery Clinics of North America - January 9, 2024 Category: Cosmetic Surgery Authors: Jeffrey Mella, Samuel Oyer Source Type: research

Prosthetic Nasal Reconstruction
Prosthetic nasal reconstruction provides a restorative option for patients with nasal defects, and these can be retained with a variety of methods including adhesives and implants. These prostheses can significantly improve appearance, self-esteem, and quality of life for patients and they restore many functions of the external nose. Traditional fabrication methods are often used by the skilled professionals who make these custom prostheses, but digital technology is improving the workflow for design and fabrication of silicone nasal prostheses. Nasal prosthetic reconstruction requires multidisciplinary coordination betwee...
Source: Facial Plastic Surgery Clinics of North America - January 5, 2024 Category: Cosmetic Surgery Authors: Michelle K. Ruse, Michaela Calhoun, Betsy K. Davis Source Type: research

Nuances in Forehead Flap Reconstruction for Large Nasal Defects
The forehead flap is a time-tested and robust resurfacing flap used for nasal reconstruction. Owing to its excellent color and texture match, acceptable donor site morbidity, and robust and independent blood supply that can support both structural and internal lining grafts, this flap remains the workhorse flap for resurfacing large nasal defects. Various nuances of this technique relating to defect and template preparation, flap design, flap elevation, flap inset, donor site closure, and pedicle division are discussed in this article. These nuances are the guiding principles for improved outcomes using a forehead flap for...
Source: Facial Plastic Surgery Clinics of North America - December 23, 2023 Category: Cosmetic Surgery Authors: Betsy Szeto, Hannah Jacobs-El, Stephen S. Park Source Type: research

Approach to Major Nasal Reconstruction
This article reviews special considerations in complex nasal defects including treatment of adjacent subunit defects, timing of repair with radiation, reconstruction in patients with prior repairs or recurrent disease, and the role of prosthetics. The role of technological advances including virtual surgical planning, 3 dimensional printing, biocompatible materials, and tissue engineering is discussed. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - December 9, 2023 Category: Cosmetic Surgery Authors: Heather K. Schopper, Shekhar K. Gadkaree, Jessyka G. Lighthall Source Type: research

Pediatric Craniomaxillofacial Fractures
Pediatric facial fractures constitute a small portion of all facial fractures. The frequency of pediatric facial fractures by location, and mechanism of injury, changes over time associated with craniofacial growth and activity. Pediatric patients have protective anatomic features, such as increased soft tissue, excess adipose tissue, and more flexible bone. Conservative management is often sufficient. Surgical intervention can often be conservative. Follow-up monitoring is valuable for concerns of growth disruption from either the trauma itself or surgical interventions. Older teenage patients may often be treated similar...
Source: Facial Plastic Surgery Clinics of North America - November 18, 2023 Category: Cosmetic Surgery Authors: Sophia Matos, Matthew D. Johnson Source Type: research